{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T18:40:44Z","timestamp":1776624044098,"version":"3.51.2"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003790","name":"Hiroshima University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003790","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Ultrasonics"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Conventional posterior ultrasound-guided selective cervical nerve root block (SNRB) often fails to deliver injectate reliably into the neural foramen, while fluoroscopic guidance involves radiation exposure and specialized equipment. We developed a novel anterior compression lateral (ACL) ultrasound-guided approach to provide radiation-free, real-time visualization with improved intraforaminal delivery. This study compared ACL with conventional ultrasound (US) and fluoroscopy (FL) in terms of needle placement accuracy and injectate distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center cohort study measured needle tip distance from the lateral mass on anteroposterior radiographs. Contrast distribution was classified as foraminal, junctional, or extraforaminal on radiographs and confirmed with axial CT in the US and ACL subgroups. Craniocaudal spread distance was also quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 114 patients with cervical radiculopathy underwent SNRB using FL (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), US (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), or ACL (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933). Radiographic intraforaminal distribution occurred in 76.8% of FL, 72.7% of ACL, and 16.0% of US injections (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Needle tips in US and ACL were positioned more lateral than FL (mean offsets 4.3\u2009\u00b1\u20096.8\u00a0mm and 2.5\u2009\u00b1\u20093.9\u00a0mm vs\u2009\u2212\u20093.5\u2009\u00b1\u20092.6\u00a0mm, respectively). Injectate spread was greater with US (30.8\u2009\u00b1\u20099.6\u00a0mm) and ACL (25.9\u2009\u00b1\u200915.1\u00a0mm) than FL (15.9\u2009\u00b1\u200910.7\u00a0mm) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). On CT, ACL achieved higher intraforaminal contrast than US (72.7% vs 16.0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). No major complications occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ACL ultrasound-guided approach delivers intraforaminal injectate with accuracy comparable to fluoroscopy while eliminating radiation exposure. It outperforms conventional posterior ultrasound in targeting consistency and offers a precise, accessible option for outpatient cervical SNRB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10396-025-01588-3","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T13:33:37Z","timestamp":1760794417000},"page":"217-225","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel technique of ultrasound-guided nerve root block: anterior compression lateral approach"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3029-2599","authenticated-orcid":false,"given":"Naofumi","family":"Hashiguchi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanoha","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinji","family":"Kotaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Ota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuo","family":"Adachi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"1588_CR1","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1007\/s00256-009-0735-5","volume":"38","author":"JW Lee","year":"2009","unstructured":"Lee JW, Park KW, Chung SK, et al. Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids. Skelet Radiol. 2009;38:1077\u201382.","journal-title":"Skelet Radiol"},{"key":"1588_CR2","doi-asserted-by":"publisher","first-page":"721","DOI":"10.3390\/jpm14070721","volume":"14","author":"HC Kose","year":"2024","unstructured":"Kose HC, GuvenKose S, Celikel F, et al. Ultrasound-guided cervical selective nerve root block versus fluoroscopy-guided interlaminar epidural injection for cervical radicular pain: a randomized, prospective, controlled study. J Pers Med. 2024;14:721.","journal-title":"J Pers Med"},{"key":"1588_CR3","doi-asserted-by":"publisher","first-page":"343","DOI":"10.36076\/ppj.2001\/4\/343","volume":"4","author":"KP Botwin","year":"2001","unstructured":"Botwin KP, Freeman ED, Gruber RD, et al. Radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections. Pain Phys. 2001;4:343\u20138.","journal-title":"Pain Phys"},{"key":"1588_CR4","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1097\/BRS.0b013e3182340096","volume":"37","author":"M Gofeld","year":"2012","unstructured":"Gofeld M, Bristow SJ, Chiu SC, et al. Ultrasound-guided lumbar transforaminal injections: feasibility and validation study. Spine (Phila Pa 1976). 2012;37:808\u201312.","journal-title":"Spine (Phila Pa 1976)"},{"key":"1588_CR5","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1097\/AAP.0b013e3181ac7e5c","volume":"34","author":"SN Narouze","year":"2009","unstructured":"Narouze SN, Vydyanathan A, Kapural L, et al. Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study. Reg Anesth Pain Med. 2009;34:343\u20138.","journal-title":"Reg Anesth Pain Med"},{"key":"1588_CR6","doi-asserted-by":"publisher","first-page":"658","DOI":"10.5535\/arm.2013.37.5.658","volume":"37","author":"Y Park","year":"2013","unstructured":"Park Y, Ahn JK, Sohn Y, et al. Treatment effects of ultrasound guide selective nerve root block for lower cervical radicular pain: a retrospective study of 1-year follow-up. Ann Rehabil Med. 2013;37:658\u201367.","journal-title":"Ann Rehabil Med"},{"key":"1588_CR7","doi-asserted-by":"publisher","first-page":"669","DOI":"10.2147\/JPR.S399431","volume":"16","author":"L Ma","year":"2023","unstructured":"Ma L, Wang Y, Yao M, et al. Evaluating the extent of ultrasound-guided cervical selective nerve root block in the lower cervical spine: evidence based on computed tomography images. J Pain Res. 2023;16:669\u201376.","journal-title":"J Pain Res"},{"key":"1588_CR8","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1136\/rapm-2020-102325","volume":"46","author":"R Ehsanian","year":"2021","unstructured":"Ehsanian R, Schneider BJ, Kennedy DJ, et al. Ultrasound-guided cervical selective nerve root injections: a narrative review of literature. Reg Anesth Pain Med. 2021;46:416\u201321.","journal-title":"Reg Anesth Pain Med"},{"key":"1588_CR9","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1007\/s00256-014-1843-4","volume":"43","author":"A Desai","year":"2014","unstructured":"Desai A, Saha S, Sharma N, et al. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability. Skeletal Radiol. 2014;43:973\u20138.","journal-title":"Skeletal Radiol"},{"key":"1588_CR10","doi-asserted-by":"publisher","first-page":"e775","DOI":"10.1016\/j.crad.2024.01.022","volume":"79","author":"Z Aldin","year":"2024","unstructured":"Aldin Z, Diss JK, Mahmood H, et al. Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment. Clin Radiol. 2024;79:e775\u201383.","journal-title":"Clin Radiol"},{"key":"1588_CR11","doi-asserted-by":"publisher","first-page":"1909","DOI":"10.3174\/ajnr.A0707","volume":"28","author":"KP Schellhas","year":"2007","unstructured":"Schellhas KP, Pollei SR, Johnson BA, et al. Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement. AJNR Am J Neuroradiol. 2007;28:1909\u201314.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR12","doi-asserted-by":"publisher","first-page":"W163","DOI":"10.7326\/0003-4819-147-8-200710160-00010-w1","volume":"147","author":"JP Vandenbroucke","year":"2007","unstructured":"Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147:W163\u201394.","journal-title":"Ann Intern Med"},{"key":"1588_CR13","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.3174\/ajnr.A6580","volume":"41","author":"FW Ott","year":"2020","unstructured":"Ott FW, Pluhm R, Ozturk K, McKinney AM, Rykken JB. Counterpoint: conventional fluoroscopy-guided selective cervical nerve root block-a safe, effective, and efficient modality in the hands of an experienced proceduralist. AJNR Am J Neuroradiol. 2020;41:1112\u20139.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR14","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1093\/pm\/pnw027","volume":"17","author":"S Kang","year":"2016","unstructured":"Kang S, Yang SN, Kim SH, et al. Ultrasound-guided cervical nerve root block: does volume affect the spreading pattern? Pain Med. 2016;17:1978\u201384.","journal-title":"Pain Med"},{"key":"1588_CR15","doi-asserted-by":"publisher","first-page":"766","DOI":"10.3174\/ajnr.A4603","volume":"37","author":"GM Lagemann","year":"2016","unstructured":"Lagemann GM, Yannes MP, Ghodadra A, et al. CT-fluoroscopic cervical transforaminal epidural steroid injections: extraforaminal needle tip position decreases risk of intravascular injection. AJNR Am J Neuroradiol. 2016;37:766\u201372.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR16","doi-asserted-by":"publisher","first-page":"468","DOI":"10.4097\/kjae.2013.65.5.468","volume":"65","author":"H Jung","year":"2013","unstructured":"Jung H, Lim JA, Park KB, et al. Computed tomography-guided cervical selective transforaminal epidural block for a patient with bilateral anatomical variations of vertebral artery -a case report-. Korean J Anesthesiol. 2013;65:468\u201372.","journal-title":"Korean J Anesthesiol"},{"key":"1588_CR17","doi-asserted-by":"publisher","first-page":"688","DOI":"10.3174\/ajnr.A3266","volume":"34","author":"JK Hoang","year":"2013","unstructured":"Hoang JK, Massoglia DP, Apostol MA, et al. CT-guided cervical transforaminal steroid injections: where should the needle tip be located? AJNR Am J Neuroradiol. 2013;34:688\u201392.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR18","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3174\/ajnr.A2835","volume":"33","author":"JT Wald","year":"2012","unstructured":"Wald JT, Maus TP, Geske JR, et al. Safety and efficacy of CT-guided transforaminal cervical epidural steroid injections using a posterior approach. AJNR Am J Neuroradiol. 2012;33:415\u20139.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR19","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.neurad.2013.08.004","volume":"41","author":"JT Wald","year":"2014","unstructured":"Wald JT, Maus TP, Diehn FE, et al. CT-guided cervical transforaminal epidural steroid injections: technical insights. J Neuroradiol. 2014;41:211\u20135.","journal-title":"J Neuroradiol"},{"key":"1588_CR20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3174\/ajnr.A3158","volume":"34","author":"TS Miller","year":"2013","unstructured":"Miller TS, Fruauff K, Farinhas J, et al. Lateral decubitus positioning for cervical nerve root block using CT image guidance minimizes effective radiation dose and procedural time. AJNR Am J Neuroradiol. 2013;34:23\u20138.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1588_CR21","doi-asserted-by":"publisher","first-page":"457","DOI":"10.36076\/ppj.2003\/6\/457","volume":"6","author":"RE Windsor","year":"2003","unstructured":"Windsor RE, Storm S, Sugar R, et al. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Phys. 2003;6:457\u201365.","journal-title":"Pain Phys"},{"key":"1588_CR22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1055\/s-0033-1354248","volume":"4","author":"K Shipley","year":"2014","unstructured":"Shipley K, Riew KD, Gilula LA. Fluoroscopically guided extraforaminal cervical nerve root blocks: analysis of epidural flow of the injectate with respect to needle tip position. Glob Spine J. 2014;4:7\u201312.","journal-title":"Glob Spine J"},{"key":"1588_CR23","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s12178-008-9041-4","volume":"2","author":"CW Huston","year":"2009","unstructured":"Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review. Curr Rev Musculoskelet Med. 2009;2:30\u201342.","journal-title":"Curr Rev Musculoskelet Med"},{"key":"1588_CR24","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1111\/j.1526-4637.2011.01170.x","volume":"12","author":"M Yamauchi","year":"2011","unstructured":"Yamauchi M, Suzuki D, Niiya T, et al. Ultrasound-guided cervical nerve root block: spread of solution and clinical effect. Pain Med. 2011;12:1190\u20135.","journal-title":"Pain Med"},{"key":"1588_CR25","doi-asserted-by":"publisher","first-page":"888","DOI":"10.2214\/AJR.10.4369","volume":"195","author":"JK Hoang","year":"2010","unstructured":"Hoang JK, Apostol MA, Kranz PG, et al. CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material. AJR Am J Roentgenol. 2010;195:888\u201394.","journal-title":"AJR Am J Roentgenol"},{"key":"1588_CR26","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.jpain.2008.07.008","volume":"10","author":"SM Rothman","year":"2009","unstructured":"Rothman SM, Huang Z, Lee KE, Weisshaar CL, Winkelstein BA. Cytokine mRNA expression in painful radiculopathy. J Pain. 2009;10:90\u20139.","journal-title":"J Pain"},{"key":"1588_CR27","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1002\/jor.1100070607","volume":"7","author":"K Olmarker","year":"1989","unstructured":"Olmarker K, Rydevik B, Holm S, et al. Effects of experimental graded compression on blood flow in spinal nerve roots. A vital microscopic study on the porcine cauda equina. J Orthop Res. 1989;7:817\u201323.","journal-title":"J Orthop Res"},{"key":"1588_CR28","doi-asserted-by":"publisher","first-page":"3350","DOI":"10.1093\/pm\/pnaa305","volume":"21","author":"A Conger","year":"2020","unstructured":"Conger A, Sperry BP, Cheney CW, et al. Does the contrast dispersion pattern during fluoroscopically guided cervical transforaminal epidural steroid injection predict short-term pain and functional outcomes? An exploratory analysis of prospective cohort data. Pain Med. 2020;21:3350\u20139.","journal-title":"Pain Med"}],"container-title":["Journal of Medical Ultrasonics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10396-025-01588-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10396-025-01588-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10396-025-01588-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T17:53:28Z","timestamp":1776621208000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10396-025-01588-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,18]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["1588"],"URL":"https:\/\/doi.org\/10.1007\/s10396-025-01588-3","relation":{},"ISSN":["1346-4523","1613-2254"],"issn-type":[{"value":"1346-4523","type":"print"},{"value":"1613-2254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,18]]},"assertion":[{"value":"12 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The institutional review board approved the study (approval number: 06-6-10), ensuring adherence to ethical guidelines and the STROBE statement for reporting observational studies.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}