DIAGNOSTIC + INTRAVENTIONAL ULTRASOUND

LATERAL FEMORAL CUTANEOUS NERVE STUDY

BACKGROUND: Since 1878 when first described by Bernhadt, the condition now known as meralgia parasthetica, or Bernhardt-Roth syndrome, has been characterized by an irritating or burning sensation in the outer thigh and is often accompanied by numbness or tingling. Nerve conduction studies verify the presence of the neuropathy, a chronic neurologic disorder, caused by compression of the lateral femoral cutaneous nerve (LFCN). Traditionally, patients will receive over-the-counter pain medication, tricyclic antidepressants or anti-seizure medications to alleviate the pain. In severe cases, surgery is performed to decompress the nerve.

THE CHALLENGE: Given its small size and curved course from the spine to the abdomen, groin and thigh, the LFCN is difficult to visualize even with modern high-frequency ultrasound machines. The nerve is easily seen just distal to the inguinal ligament, but tends to disappear from view just beyond it.

THE GOAL: Dr. Bodor and colleagues have noticed that it is possible to see the nerve where it courses under the inguinal ligament by directing the ultrasound beam at a 30 degree angle as opposed to the usual 0 degrees. This enables visualization of the nerve where it is typically compressed. Dr. Bodor believes that this will improve the treatment of meralgia paresthetica by improving diagnosis and targeted treatment including injections and ultrasound-guided surgery to decompress the nerve.

We are currently enrolling up patients with symptoms of pain, burning and numbness in the outside or front of the thigh to determine the optimal angle of visualization of the LFCN and improve our methods of diagnosing and treating LFCN neuropathy.

CERVICAL FACET INJECTION STUDY

BACKGROUND: Neck pain is a common complaint among individuals age 50 and over. Among those 50 and over with chronic neck pain and restriction of range of motion, up to 40-50% suffer from osteoarthritis of the facet joints. Current treatments include corticosteroid injection and the delivery of biologic agents, such as platelet-rich plasma or bone marrow aspirate concentrate containing stem cells.

Prior to the refinement of ultrasound-guided delivery methods, many the facet joints could only be injected using fluoroscopic (x-ray) guidance. The disadvantages of x-ray include: 1) radiation exposure, 2) a 2-dimensional approach that often necessitates painful contact with the bone, and 3) use of a contrast agent to ensure needle placement which reduces the space available for the therapeutic medication, possibly neutralizes the effectiveness of biologic agents, and risks allergic reaction. Difficult to perform and time consuming, the fluoroscopic technique may be less than 80% accurate.

When unsuccessful, many patients are driven toward a significantly more costly and invasive procedure: radiofrequency ablation of the medial branch nerves using microwaves. These nerves contribute to rotation and angulation of the head and neck. Ablating these nerves in the lumbar spine has been shown to accelerate disc degeneration and could do the same in the cervical spine.

HYPOTHESIS: Using our ultrasound-guided technique, full doses of biologic agents can be delivered with greater accuracy directly to the affected area without harm of radiation.

CURRENT RESEARCH FINDINGS: We have succeeded in our goal of developing a technique using ultrasound & fluoroscopy. As of August 2017, we have done intradiscal PRP on 201 patients, 482 discs and total of 244 procedures including the cervical, thoracic and lumbar.

GOAL: Dr. Bodor and Yvette Uribe have begun preparing their findings for submission to either the Journal of Ultrasound Medicine, Spine, or Physical Medicine & Rehabilitation Journal. Dr. Naven Murthy of the Mayo Clinic will co-author.

 Reduce Pain. Increase Mobility + Function. Improve Quality of Life.

All the research conducted through the Napa Medical Research Foundation, a 501(c)(3) nonprofit organization, is fully funded through generous donations received from individuals and family foundations.

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