Ultrasound-guided lumbar medial branch blocks and intra-articular facet joint injections: a systematic review and meta-analysis

Ashmore, Zachary; Bies, Michael M.; Meiling, James B.; Moman, Rajat N.; Hassett, Leslie; Hunt, Christine; Cohen, Steven P.; Hooten, W. Michael

doi:10.1097/pr9.0000000000001008

Cited by 6 publications

(13 citation statements)

References 54 publications

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“…Nevertheless, the technical limitations of ultrasound, the tissue depth of lumbar nerve roots and individual patient characteristics could determine the precision of ultrasound-guided procedures in the lumbar spine. 3 These results support that other guidance techniques would be required to properly reach L5 nerve root if not being visualized clearly with ultrasound.…”

Section: Discussionsupporting

confidence: 71%

“…For these reasons, efforts are being made to increase the use of ultrasound guidance for several procedures in the lumbar spine. 3 Nevertheless, there are concerns about its validity because the ultrasound-guided approach to vertebral structures of the lumbar spine can be difficult because of its three-dimensional complex anatomy, with high acoustic impedance of vertebral references. 10 In addition, the presence of anatomical variations such as a lumbosacral transitional vertebra is estimated to be present in 4%-30% of the population.…”

Section: What Is Newmentioning

confidence: 99%

“…Minimally invasive techniques for managing low back pain are receiving increasing attention due to their potential advantages. These techniques include procedures such as facet joint nerve block, nerve root block, epidural block, lumbar transforaminal epidural steroid injections, sacroiliac joint blocks, and intra-articular facet injections 3 . However, clinical guidelines conclude that their effectiveness depends on the accuracy in reaching the targeted structure, requiring their visualization in real time 2 …”

Section: Introductionmentioning

confidence: 99%

“…In addition, ultrasound devices are affordable; several can be easily transported, and, more importantly, they avoid the ionizing radiation that occurs with fluoroscopy or computed tomography. For these reasons, efforts are being made to increase the use of ultrasound guidance for several procedures in the lumbar spine 3 . Nevertheless, there are concerns about its validity because the ultrasound-guided approach to vertebral structures of the lumbar spine can be difficult because of its three-dimensional complex anatomy, with high acoustic impedance of vertebral references 10…”

Section: Introductionmentioning

confidence: 99%

“…These techniques include procedures such as facet joint nerve block, nerve root block, epidural block, lumbar transforaminal epidural steroid injections, sacroiliac joint blocks, and intra-articular facet injections. 3 However, clinical guidelines conclude that their effectiveness depends on the accuracy in reaching the targeted structure, requiring their visualization in real time. 2 The American Society of Regional Anesthesia and Pain Medicine recognizes that the leading cause of failure of invasive block techniques and the occurrence of complications (such as nerve injury) is incorrect needle placement.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Ultrasound-Guided Needle Placement on the L5 Lumbar Nerve Root: A Cadaveric Study

Rodríguez-Sanz

Borrella-Andrés

Pérez‐Bellmunt

et al. 2023

Am J Phys Med Rehabil

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Objectives The aims of the study are to analyze and describe the accuracy of an ultrasound-guided approach to target the L5 root in cadaveric specimens and evaluate whether gender differences exist. Design A cross-anatomical study on 40 cadaver L5 nerve roots was performed. A needle was introduced until contacting the L5 nerve root using ultrasound guidance. After that, specimens were frozen and studied by a cross-anatomical view to see the needle’s path. The angulation, length, distance from the vertebral spine, the relevant ultrasound anatomical references, and the accuracy of the procedure were evaluated. Results The needle tip reached the L5 root at a 72.5% rate. The mean angulation degrees of the needle relative to the skin surface were 75.53 ± 10.17 degrees, the length of the needle inserted was 5.83 ± 0.82 cm, and the distance from the vertebral spine to the point of entry of the needle was 5.39 ± 1.44 cm. Conclusions An ultrasound-guided technique can potentially be an accurate technique to perform invasive procedures on the L5 root. There were statistically significant differences between males and females in the length of the needle introduced. If the L5 root is not clearly visualized, ultrasound will not be the technique of choice.

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Section: Discussionsupporting

confidence: 71%

Section: What Is Newmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Accuracy of Ultrasound-Guided Needle Placement on the L5 Lumbar Nerve Root: A Cadaveric Study

Rodríguez-Sanz

Borrella-Andrés

Pérez‐Bellmunt

et al. 2023

Am J Phys Med Rehabil

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Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review

Wong

Rajarathinam

2023

Canadian Journal of Pain

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Background Axial facet joint interventions (e.g., medial branch block and radiofrequency ablation, facet joint intra-articular injection) are commonly performed for managing chronic spinal pain. Although traditionally performed with fluoroscopy or computed tomography (CT) guidance, ultrasound-guided techniques have also been developed for these interventions. Aims The aim of this study is to present contemporary ultrasound-guided techniques for facet joint interventions and synthesize data addressing their accuracy, safety, and efficacy. Methods The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of ultrasound-guided facet joint interventions with human subjects from November 1, 1992, to November 1, 2022. Additional sources were drawn from reference lists and citations of relevant studies. Results We found 48 studies assessing ultrasound-guided facet joint interventions. Ultrasound guidance for injection of the cervical facet joints and their innervating nerves had favorable accuracy (78%–100%), with lower procedural time compared to fluoroscopy or CT guidance and comparable pain relief. Accuracy with ultrasound-guided lumbar facet joint intra-articular injection (86%–100%) was more reliable than medial branch block (72%–97%); analgesia was comparable to fluoroscopy and CT guidance. In general, these procedures were more challenging for patients with obesity, and deeper structures were more difficult to accurately target (e.g., lower cervical levels, L5 dorsal ramus). Conclusions Ultrasound-guided facet joint interventions continue to evolve. Some technically challenging interventions may be impractical for widespread usage or require further technical refinement. The utility of ultrasound guidance with obesity and abnormal anatomy may be reduced.

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3. Pain originating from the lumbar facet joints

Van den Heuvel,

Cohen,

de Andrès Ares

et al. 2023

Pain Practice

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IntroductionPain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well‐designed studies, the prevalence is generally between 10% and 20%, increasing with age.MethodsThe literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.ResultsThere are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni‐ or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non‐dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After “red flags” are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.ConclusionsWell‐selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

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Ultrasound-guided lumbar medial branch blocks and intra-articular facet joint injections: a systematic review and meta-analysis

Cited by 6 publications

References 54 publications

Accuracy of Ultrasound-Guided Needle Placement on the L5 Lumbar Nerve Root: A Cadaveric Study

Accuracy of Ultrasound-Guided Needle Placement on the L5 Lumbar Nerve Root: A Cadaveric Study

Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review

3. Pain originating from the lumbar facet joints

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