Transverse Process and Needles of Medial Branch Block to Facet Joint as Landmarks for Ultrasound-Guided Selective Nerve Root Block
Clinics in Orthopedic Surgery
;
: 44-48, 2013.
Artículo
en Inglés
| WPRIM
| ID: wpr-88119
ABSTRACT
BACKGROUND:
Selective 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.METHODS:
We 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.RESULTS:
Seven 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.CONCLUSIONS:
For 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.
Texto completo:
Disponible
Índice:
WPRIM (Pacífico Occidental)
Asunto principal:
Ciática
/
Estenosis Espinal
/
Enfermedad Crónica
/
Dolor de la Región Lumbar
/
Articulación Cigapofisaria
/
Vértebras Lumbares
/
Bloqueo Nervioso
Tipo de estudio:
Guía de Práctica Clínica
Límite:
Adulto
/
Anciano
/
Aged80
/
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Clinics in Orthopedic Surgery
Año:
2013
Tipo del documento:
Artículo
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