Ultrasound-Guided Lumbar Facet Nerve Block and Intra-articular injection

2018 ◽  
pp. 117-123
Author(s):  
David M. Irwin ◽  
Michael Gofeld
Keyword(s):  
Nerve Block ◽  
Ultrasound Guided ◽  
Lumbar Facet

Lumbar Facet Nerve Block: Ultrasound

2016 ◽  
Author(s):  
David A. Provenzano
Keyword(s):  
Nerve Block ◽  
Iliac Crest ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Detailed Understanding ◽  
Medial Branch Block ◽  
Body Mass Indexes ◽  
Lumbar Facet ◽  
Correct Level ◽  
The Ideal

This chapter describes the relevant anatomy and sonoanatomy and the ultrasound-guided technique for lumbar medial branch blocks. The ultrasound-guided lumbar medial branch block is an intermediate level block. Prior to performing this block, it is important to have a detailed understanding of lumbar sonoanatomy in order to be able to target the correct level, the lumbar medial branch and the L5 dorsal ramus zones. In those individuals with body mass indexes in the ideal range, current studies suggest the L3 and L4 medial branches can be successfully targeted. The L5 dorsal ramus may be challenging secondary to the iliac crest, which may limit the ultrasound views needed for the target zone. Further technical and equipment advancements are needed to improve and reduce the existing limitations associated with the ultrasound-guided lumbar medial branch block technique.

Ultrasound-guided Lumbar Facet Nerve Block

2004 ◽  
Vol 100 (5) ◽  
pp. 1242-1248 ◽  
Author(s):  
Manfred Greher ◽  
Gisela Scharbert ◽  
Lars P. Kamolz ◽  
Harald Beck ◽  
Burkhard Gustorff ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Nerve Block ◽  
Statistical Significance ◽  
Target Point ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Cross Axis ◽  
Lumbar Facet ◽  
Axis View

Background Lumbar facet nerve (medial branch) block for pain relief in facet syndrome is currently performed under fluoroscopic or computed tomography scan guidance. In this three-part study, the authors developed a new ultrasound-guided methodology, described the necessary landmarks and views, assessed ultrasound-derived distances, and tested the clinical feasibility. Methods (1) A paravertebral cross-axis view and long-axis view were defined under high-resolution ultrasound (15 MHz). Three needles were guided to the target point at L3-L5 in a fresh, nonembalmed cadaver under ultrasound (2-6 MHz) and were subsequently traced by means of dissection. (2) The lumbar regions of 20 volunteers (9 women, 11 men; median age, 36 yr [23-67 yr]; median body mass index, 23 kg/m2 [19-36 kg/m2]) were studied with ultrasound (3.5 MHz) to assess visibility of landmarks and relevant distances at L3-L5 in a total of 240 views. (3) Twenty-eight ultrasound-guided blocks were performed in five patients (two women, three men; median age, 51 yr [31-68 yr]) and controlled under fluoroscopy. Results In the cadaver, needle positions were correct as revealed by dissection at all three levels. In the volunteers, ultrasound landmarks were delineated as good in 19 and of sufficient quality in one (body mass index, 36 kg/m2). Skin-target distances increased from L3 to L5, reaching statistical significance (*, **P < 0.05) between these levels on both sides: L3r, 45+/-6 mm*; L4r, 48+/-7 mm; L5r, 50+/-6 mm*; L3l, 44+/-5 mm**; L4l, 47+/-6 mm; L5l, 50+/-6 mm**. In patients, 25 of 28 ultrasound-guided needles were placed accurately, with the remaining three closer than 5 mm to the radiologically defined target point. Conclusion Ultrasound guidance seems to be a promising new technique with clinical relevance and the potential to increase practicability while avoiding radiation in lumbar facet nerve block.

Ultrasound-guided lumbar facet nerve block: high accuracy of a new technique confirmed by CT-scan control

2004 ◽  
Vol 21 (Supplement 32) ◽  
pp. 112
Author(s):  
M. Greher ◽  
L. Kirchmair ◽  
B. Enna ◽  
P. Kovacs ◽  
B. Gustorff ◽  
...  
Keyword(s):  
Ct Scan ◽  
Nerve Block ◽  
High Accuracy ◽  
New Technique ◽  
Ultrasound Guided ◽  
A New Technique ◽  
Lumbar Facet

Ultrasound-guided Lumbar Facet Nerve Block

2004 ◽  
Vol 101 (5) ◽  
pp. 1195-1200 ◽  
Author(s):  
Manfred Greher ◽  
Lukas Kirchmair ◽  
Birgit Enna ◽  
Peter Kovacs ◽  
Burkhard Gustorff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Medium ◽  
Nerve Block ◽  
Facet Joint ◽  
Target Point ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Ultrasound Technique ◽  
Computed Tomography Scans ◽  
Lumbar Facet

Background Lumbar facet nerve (medial branch) blocks are often used to diagnose facet joint-mediated pain. The authors recently described a new ultrasound-guided methodology. The current study determines its accuracy using computed tomography scan controls. Methods Fifty bilateral ultrasound-guided approaches to the lumbar facet nerves were performed in five embalmed cadavers. The target point was the groove at the cephalad margin of the transverse (or costal) process L1-L5 (medial branch T12-L4) adjacent to the superior articular process. Axial transverse computed tomography scans, with and without 1 ml contrast dye, followed to evaluate needle positions and spread of contrast medium. Results Forty-five of 50 needle tips were located at the exact target point. The remaining 5 were within 5 mm of the target. In 47 of 50 cases, the applied contrast dye reached the groove where the nerve is located, corresponding to a simulated block success rate of 94% (95% confidence interval, 84-98%). Seven of 50 cases showed paraforaminal spread, 5 of 50 showed epidural spread, and 2 of 50 showed intravascular spread. Despite the aberrant distribution, all of these approaches were successful, as indicated by contrast dye at the target point. Abnormal contrast spread was equally distributed among all lumbar levels. Contrast traces along the needle channels were frequently observed. Conclusions : The computed tomography scans confirm that our ultrasound technique for lumbar facet nerve block is highly accurate for the target at all five lumbar transverse processes (medial branches T12-L4). Aberrant contrast medium spread is comparable to that of the classic fluoroscopy-guided method.

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