DIAGNOSTIC + INTRAVENTIONAL ULTRASOUND
LATERAL FEMORAL CUTANEOUS NERVE STUDY (IRB ApPROVED)
BACKGROUND: Since 1878 when first described by Bernhardt, 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 certain angle. This enables visualization of the nerve where it is typically compressed. Dr. Bodor believes that by determining the optimal angle of visualization, we will improve diagnosis and be able to deliver targeted treatment including injections and ultrasound-guided surgery to decompress the nerve.
STATUS: Institutional Review Board (IRB) approval for this study was obtained through St. Joseph Health. We currently have 14 patients enrolled, and plan to enroll 25-30. Study participants will exhibit symptoms of pain, burning and numbness in the outside or front of the thigh.
To inquire about study participation, please call Yvette Uribe at (707) 690-2459.
CERVICAL FACET INJECTION STUDY (IRB APPROVED)
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.
METHODS: Dr. Bodor performed 60 ultrasound-guided cervical facet injections on 40 patients with fluoroscopy confirmation. All images were reviewed by Dr. Bodor and by an independent musculoskeletal radiologist. The results showed 93% and 90% accuracy respectively with using ultrasound.
STATUS: The paper is being written and will then be submitted to a clinical journal.
CARPAL TUNNEL FLOW STUDY (IRB APPROVED)
PURPOSE: Assessing the accuracy of ultrasound-guided carpal tunnel injections with fluoroscopy confirmation.
BACKGROUND: Carpal Tunnel Syndrome and its respective treatments has been studied extensively for the past several years. Ultrasound guidance has become a common tool to use for accuracy, effectiveness and safety; however, different techniques has been developed. We believe our technique allows for the best possible visualization of the targeted structures. If our technique becomes the standard, ultrasound-guided carpal tunnel injections can be safely administered, with little to no pain and most importantly with the highest degree of accuracy, thereby ensuring maximum relief and avoiding possibly harmful targets/structures.
METHODS: Patients identified as having carpal tunnel syndrome based on clinical and electrodiagnostic criteria will receive a corticosteroid + lidocaine + Isovue (contrast) injection proximal to the carpal tunnel, followed by fluoroscopic images to confirm the flow of the injectate into the correct location. The fluoroscopic images will be viewed by Dr. Bodor and the determination will be made as to whether the flow has reached the targeted area. The data will be reviewed by an independent musculoskeletal radiologist to confirm/deny our findings.
STATUS: 20 patients have been enrolled and plan to enroll 30 total.
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.