The Development of a New Medical Technique

Nearly 15 years in the making
Innovations and breakthroughs can be the result of years’ worth of effort, multiple failures, and even happy accidents. For Dr. Marko Bodor, it was the driving need to ensure his patients were being diagnosed and treated in the most accurate, timely, effective and safe manner possible. It is why he took many years to develop, perfect, and ultimately prove the effectiveness of an ultrasound-guided injection technique with a 97% accuracy rate that does not require the use of radiation.
In 2003, Dr. Bodor started using ultrasound, together with electromyography and nerve conduction studies, for the diagnosis of peripheral nerve disorders, such as Carpal Tunnel Syndrome. Musculoskeletal ultrasound offers a higher resolution image when compared to MRI when examining nerves, muscles, tendons, and ligaments located closer to the surface of the patient’s skin. A non-invasive procedure, ultrasound is a real-time imaging modality that allows for patient interaction – no sedatives, immobility, or fixed screen images.
At the time, the great experts in musculoskeletal ultrasound (US) were to be found in Europe. Paradoxically, magnetic resonance imaging (MRI) machines were more expensive and less available than in the US, so leading physicians like Carlo Martinoli were capitalizing on the accessibility of ultrasound and creating a game changer for diagnosticians worldwide. Dr. Bodor traveled to Europe during this time to attend conferences to learn how to optimize this technology, befriending Martinoli and other leaders in the field.
Back in the US, Dr. Bodor and his colleagues at Mayo Clinic – Dr. Jay Smith included – were wholly embracing this technology. As the quality of ultrasound advanced exponentially between 2003 and 2010, Drs. Martinoli and Smith would become acclaimed experts with ultrasound in the realm of sports medicine with the diagnosis and treatment of peripheral joints, tendons, and ligaments. Dr. Bodor, whose focus was both sports medicine and the spine, would take the technology in a different direction.
By 2008, he would develop a new way of injecting the small joints in the neck – cervical facet joints – bringing musculoskeletal ultrasound to the world of the spine.
Considered the most common source of neck pain in older adults, cervical facet joints are relatively close to the skin, but are also close to major arteries and veins. Injections of anti-inflammatory or biologic treatments into the joint can greatly reduce pain and increase mobility for the patient, but to access the joint is tricky. Spine injections, then, and still in many places around the world today, are made with x-ray or fluoroscopic guidance. The advantage is that these imaging modalities see through soft tissues and bone. They also have two distinct disadvantages: the limitation of 2-dimensionality and the use of radiation.
Dr. Bodor wanted to make sure every patient left the office feeling better than when they walked in, and did not want for them to have to wait for an appointment with the hospital outpatient radiology department. Some patients might require more than one image to determine where the needle needed to be placed, how deep to go before hitting bone and causing the patient great discomfort, or the needle’s proximity to vital veins and arteries.
Drawing on his extensive experience with musculoskeletal ultrasound, he had the ability to conduct ultrasound imaging in his office – in real time, with no wait or visit to the hospital, and without radiation. Dr. Bodor could fully visualize the affected area while efficiently delivering the necessary medication directly into the joint.
Since then, he has performed over 10,000 such injections with a perfect safety record. Recently, he and his fellows completed the Cervical Facet Injection Study, comprising 60 consecutive cervical facet injections, read more here. They used fluoroscopy as an independent assessment of whether or not the flow of medication was in the joint or not. As judged by Naveen Murthy, MD, an independent radiologist from Mayo Clinic, 97% of the injections were shown to be definitely in the joint, outperforming the current success rate of 91% achieved through fluoroscopic guidance. A definitive paper on ultrasound guidance for cervical facet injections is currently being prepared to demonstrate this technique.
The Napa Medical Research Foundation is honored to serve the medical community by ensuring the broad sharing of this technique so that others may improve the delivery of their healthcare to people across the country, and around the world. We look forward to sharing this publication with you in the coming months.

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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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