The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity

Irwin, Ann; Khan, Almas; Fender, D.; Sanderson, P. L.; Gibson, Michael J.

doi:10.1007/s00586-014-3188-z

Cited by 11 publications

(17 citation statements)

References 25 publications

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“…Many studies report triple neurectomy of these three nerves for the surgical management of refractory neuropathic groin pain with high success rates of 85% to 97% (1,10,32). Although, selective spinal nerve blocks are also associated with complications (20), they can be safely performed under guidance of fluoroscopy even in patients with spinal deformities (17). A major transient problem with these blocks is inappropriate spreading of local anesthetics (18).…”

Section: █ Resultsmentioning

confidence: 99%

Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia

Kale

Gürbüz²,

Çam³

et al. 2018

Turkish Neurosurgery

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Section: █ Resultsmentioning

confidence: 99%

Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia

Kale

Gürbüz²,

Çam³

et al. 2018

Turkish Neurosurgery

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“…Other literature also support the use of 0.5 mL for the diagnosis of SNRB. [19][20][21] Thus, 0.5 mL of liquid medicine (0.25 mL of 1% lidocaine and 0.25 mL of betamethasone) was selected for blocking as well as for achieving good results.…”

Section: Discussionmentioning

confidence: 99%

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

Yue

Shen

et al. 2019

J Int Med Res

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Objective To establish a management strategy for multi-segment lumbar lateral recess stenosis. Methods A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30–70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED. Results Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group. Conclusion A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.

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“…Radiculopathy is frequently encountered in patients who have undergone posterior transpedicular stabilization (PTS) surgery [ 1 - 4 ]. Anamnesis, neurological examination, electrodiagnostic tests, and magnetic resonance imagination are often used to diagnose the root generated pain [ 2 , 5 , 6 ]. However, the above-mentioned diagnostic modalities are sometimes insufficient for diagnosis because of the patients' advanced age and some degree of ongoing lumbar degenerative changes already present in these patients [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Does the Position of the Polyaxial Screw Head in Patients With L5-S1 Stabilization Lead to an Increased Difficulty in L5 Transforaminal Nerve Injection? A Three-Dimensional Computerized Tomography Study

Güleç

Güzey

2021

Cureus

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Background Challenges may be encountered if transforaminal nerve injection (TFNI) is required in patients who have undergone posterior transpedicular stabilization (PTS) surgery to the L5-S1 level. In this study, we investigated the contributory factors that lead to these challenges. Methods We selected 125 patients who underwent PTS surgery involving the L5-S1 segment, between 18 to 70 years of age to be included in the study. The demographic data of the patients, body mass indexes (BMI), postoperative spondylolisthesis grades, heights of the iliac crest, and the positions of the polyaxial screw head were assessed. The shortest trajectory of L5-TFNI, the distance of the needle entry point (NEP) to the midline, and optimum viewing angles (VA) were measured on the three-dimensional computed tomography (CT) sections. Results Pre-PTS surgery, in males compared to females, NEP was noted to be more medial (p=0.007), the needle trajectory was shorter (p=0.001), and the optimal VA was narrower (p=0.001). Increasing BMI and increasing height of the iliac crest caused the TFNI trajectory to become longer. Post-PTS surgery, angulation of polyaxial screw heads of more than 15 degrees laterally in both genders significantly caused a decrease in VA (p=0.001). Conclusions Using the reconstruction technique in 3D CT, we demonstrated that pedicle screw heads angled laterally, a higher iliac crest height, and an increased BMI make L5-TFNI difficult to be performed. Locking the stabilization system while targeting the most neutral position for polyaxial screw heads during surgery may facilitate the L5-TFNI.

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The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity

Abstract: Purpose The specificity of a selective nerve root block (SNRB) is dependant on isolating only the required nerve root whilst avoiding injectate flow to traversing nerves.

Cited by 11 publications

References 25 publications

Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia

Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia

Accurate location and minimally invasive treatment of lumbar lateral recess stenosis with combined SNRB and PTED

Does the Position of the Polyaxial Screw Head in Patients With L5-S1 Stabilization Lead to an Increased Difficulty in L5 Transforaminal Nerve Injection? A Three-Dimensional Computerized Tomography Study

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