Transverse Process and Needles of Medial Branch Block to Facet Joint as Landmarks for Ultrasound-Guided Selective Nerve Root Block

Abstract

BackgroundSelective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography.MethodsWe performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results.ResultsSeven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 ± 0.6 to 3.5 ± 1.3 after the procedure.ConclusionsFor SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.

Blocs périnerveux dans le traitement de la douleur chronique

“…À côté des blocs périnerveux, existent d'autres techniques : infiltrations et blocs de l'axe rachidien, neuromodulation percutanée, infiltrations articulaires [42][43][44][45]. La littérature renferme de nombreux cas cliniques et séries non contrôlées ou rétrospectives, ne comportant généralement que de faibles effectifs, souvent inhomogènes.…”

Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections

“…21 Even if the needle was not placed in the correct position, the symptoms might be relieved by systemic drug effect, thus leading to inadequate estimation of the accuracy. 22 We evaluated the accuracy by checking the placement of the needle tip and distribution of the contrast medium with FL. The data demonstrated that TFEI under US guidance was a new and safe technique.…”

Protecting Surgeons' Fingers from Radiation Exposure during Lumbosacral Selective Nerve Root Block

“…Yet, the exposure of the hands of sur-geons who perform fluoroscopically-guided spinal procedures, including SNRB, routinely has been estimated at 1,472 mSv/year 7) . Although ultrasound-guided SNRB was shown to be as effective as the fluoroscopy-guided method for the cervical spine, the rate of successful needle positioning in the lumbosacral spine with ultrasound guidance is only 63-89% 8,9) . Therefore, fluoroscopy-guided SNRB is recommended for the lumbosacral spine, requiring the use of a device to protect the surgeons' hands from radiation exposure.…”