Ultrasound versus Fluoroscopy-Guided Selective Lumbar Nerve Root Injections: A Comparative Analysis of Efficacy, Safety, and Outcomes

Background: Lumbosacral radiculopathy, often due to degenerative disc disease, is commonly treated with epidural steroid injections (ESIs). Fluoroscopy (FL)-guided injections are the standard approach but involve radiation exposure. Ultrasound (US) guidance provides a radiation-free alternative with real-time soft tissue visualization. Objective: To compare the efficacy, safety, and functional outcomes of US-guided versus FL-guided selective lumbar nerve root injections. Methods: This prospective, randomized study included 57 patients with lumbar radiculopathy refractory to conservative treatment. Patients were randomized into two groups: Group 1 (US-guided, n = 27) and Group 2 (FL-guided, n = 30). Pain relief was assessed using the Visual Analog Scale (VAS), and functional improvement was evaluated with the Oswestry Disability Index (ODI) at baseline, 1 week, 1 month, and 3 months. Secondary outcomes included procedural time, patient satisfaction, complication rates, and post-procedure medication use. Results: At 3 months, FL-guided injections achieved significantly lower VAS scores (2.8 ± 0.71 vs. 3.4 ± 0.89, P = 0.008). No significant differences were observed in ODI improvement between groups at 1 week (P = 0.063), 1 month (P = 0.525), or 3 months (P = 0.956). Procedural time was comparable (P = 0.168), and patient satisfaction scores were similar (P = 0.966). Both groups had low complication rates, with no serious adverse events. Conclusion: FL-guided injections provide superior long-term pain relief, while US guidance eliminates radiation exposure. Larger, multicenter studies are needed to validate these findings and assess the influence of operator expertise and patient-specific factors.