scholarly journals Spread of Contrast During L4 and L5 Nerve Root Infiltration Under Fluoroscopic Guidance

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 461-466
Author(s):  
Dmitri Vassiliev
Keyword(s):  
Nerve Root ◽  
Water Soluble ◽  
Fluoroscopic Guidance ◽  
Lumbar Radiculopathy ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Significant Difference ◽  
Lumbar Segment ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Background: Lumbar selective nerve root blocks have been performed to establish the origin of lumbar radiculopathy in clinically difficult cases. The diagnostic ability of selective nerve root blocks remains controversial because of concern over potential spread of an injectate onto adjacent structures. Objective: To investigate the spread of different volumes of water-soluble contrast during L4 and L5 selective nerve root blocks. Design: Retrospective, observational case series. Methods: Analysis of medical records and X-ray images obtained during L4 and L5 selective nerve root blocks. Results: During L4 selective nerve root block 1 ml of contrast spread onto L5 nerve roots in 46.1% of subjects and during L5 nerve root block 1 ml of contrast spread onto S1 nerve root in 57.7%. There was statistically significant difference (p<0.0001) between spread of contrast onto the medially located nerve root in the same lumbar segment and nerve roots in the lumbar segment above. Conclusions: Injection of 1 ml of contrast under fluoroscopic guidance does not guarantee selective spread of the contrast around L4 or L5 nerve roots only. There is also spread toward the more medial nerve root in the same spinal segment during L4 and L5 nerve root infiltration. These findings suggest that it is possible to differentiate between L4 and L5 nerve root pathology using a sequential nerve root blocks under fluoroscopic guidance. Key words: Selective nerve root block, Lumbar radiculopathy, Fluoroscopic guidance

Lumbar nerve root blocks using MRI – the effectiveness and safety of ultrasound/MRI fusion image guidance

2021 ◽  
Author(s):  
David John Wilson ◽  
Gina Allen ◽  
Stuart Bullock ◽  
Jon Denton
Keyword(s):  
Nerve Root ◽  
Fusion Imaging ◽  
Fluoroscopic Guidance ◽  
Imaging Guidance ◽  
Patient’S Satisfaction ◽  
Nerve Root Block ◽  
Lumbar Nerve Root ◽  
Significant Difference ◽  
Nerve Root Blocks ◽  
Clinical Records

Objective: To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. Methods: This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks. We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance. Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient’s satisfaction, complications and the duration of the procedures. Results: Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group. The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399). At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups. The patient’s satisfaction scores were similar for both groups. The procedure by the two guidance methods took a similar time to perform. There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. Conclusion: Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. Advances in knowledge: Fusion imaging guidance provides the same outcome as fluoroscopic guidance. Fusion imaging guidance avoids the need for ionising radiation.

Thoracic Epidural and Nerve Root Injections: Fluoroscopy

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Nerve Root ◽  
Small Volume ◽  
Epidural Block ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Thoracic Epidural ◽  
Thoracic Nerve ◽  
Transforaminal Approach ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Thoracic nerve root blocks can be achieved by interlaminal epidural, transforaminal epidural, paravertebral, and selective nerve root injections. The interlaminal approach allows blocking multiple nerve roots bilaterally, while the transforaminal approach has the advantage of depositing the injectate primarily to the anterior epidural space on the side of the injection, closer to the pathology. The paravertebral approach is often used to block multiple nerve roots on the side of injection, and the selective nerve root block is used to target a specific nerve root using a small volume of injectate. Fluoroscopy-guided injection the most commonly used technique. Contrast materials are often used to confirm the appropriate needle placement and monitor the spread of the injectate. Thoracic nerve root block and transforaminal epidural block are perceived as technically demanding due to anatomic complexity of the thoracic spine, its proximity to the lungs and major vasculature, and potential complications.

scholarly journals Variations in selective nerve root block technique

2013 ◽  
Vol 95 (7) ◽  
pp. 515-518 ◽  
Author(s):  
NC Eastley ◽  
V Spiteri ◽  
ML Newey
Keyword(s):  
Local Anaesthetic ◽  
Nerve Root ◽  
Lumbar Radiculopathy ◽  
Vertebral Disc ◽  
Injection Techniques ◽  
Nerve Root Blocks ◽  
Tip Position ◽  
The Uk ◽  
Selective Nerve Root Block ◽  
Prolapsed Disc

Introduction Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits. We investigated the variation in injection techniques of practitioners working in the UK. Methods A clinical scenario was devised depicting a patient with radiculopathy secondary to an L4/5 vertebral disc prolapse. Participants were questioned on their chosen management of this patient, focusing particularly on SNRB technique. Questionnaires were sent to spinal surgeons, pain management specialists and musculoskeletal radiologists. Results A total of 100 responses were detailed enough for inclusion. The majority (83%) of respondents reported they would inject local anaesthetic and steroids, 4% would inject local anaesthetic alone and 13% would inject a different substance. Over half (53%) would target the L5 nerve root, 26% the L4 nerve root, 12% the prolapsed disc itself and 9% two separate vertebral levels. Variation was also noted in needle tip location relative to the neural sheath. Conclusions When treating lumbar radiculopathy, there are apparent variations in the use and positioning of SNRBs for a given level of disc pathology. Needle tip position may have a direct influence on clinical outcome following SNRBs. Caution is therefore required when considering the validity of previously published studies investigating SNRBs and different injectates.

scholarly journals The Effectiveness of a Selective Nerve Root Block for Lumbar Radiculopathy

2011 ◽  
Vol 60 (1) ◽  
pp. 95-100
Author(s):  
Tomonao Chikama ◽  
Ko Ikuta ◽  
Nobuhiko Yokoyama ◽  
Yusuke Takahashi ◽  
Takahiro Kitamura ◽  
...  
Keyword(s):  
Nerve Root ◽  
Lumbar Radiculopathy ◽  
Nerve Root Block ◽  
Selective Nerve Root Block

scholarly journals Clinical Efficacy of Selective Nerve Root Block in Lumbar Radiculopathy due to Disc Prolapse

2019 ◽  
Vol 17 (2) ◽  
pp. 242-246 ◽  
Author(s):  
Gaurav Raj Dhakal ◽  
Pawan Kumar Hamal ◽  
Siddhartha Dhungana ◽  
Yoshiharu Kawaguchi
Keyword(s):  
Nerve Root ◽  
Index Score ◽  
Lumbar Radiculopathy ◽  
Disc Prolapse ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain ◽  
Nerve Root Block ◽  
Oswestry Disability Index Score ◽  
One Year ◽  
Selective Nerve Root Block

Background: Selective Nerve Root Block using steroid is a proven technique for management of lumbar radiculopathy. The aim of the study was to determine the effectiveness of selective nerve root block in lumbar radiculopathy.Methods: A prospective observational study was conducted for duration of one year in patients diagnosed with lumbar radiculopathy. Patients with leg pain, positive straight leg raising test and single level disc prolapse were included in the study. The procedure was performed under fluoroscopic guidance and Visual Analogue Pain rating scale and Oswestry Disability Index score was used for assessment pre-injection, 1 week, 1 month, 6 months and 1-year post injection.Results: Total 35 patient with mean age of 37.7± 9.31 years were included in the study. The pre-injection Visual Analogue Pain Score(Mean ± S.D:7.8±0.7) was significantly reduced at one week (4.2±1.47, p <0.00001), one month (2.74±1.06, p <0.00001), six months (2.31±0.75, p <0.00001) and one year (2.62±0.84, p <0.00001). Similarly, pre-injection Oswestry Disability Index score (Mean ± S.D: 32.09±5.95) was significantly reduced at one week (19.51±7.26, p <0.00001), one month (12.71±4.56, p <0.00001), six months (9.8±2.87, p <0.00001) and one year (10.09±2.97, p <0.00001) but not significantly improved when compared at 6 months and 1 year (p < 0.44).Conclusions: Selective Nerve Root Block in lumbar radiculopathy significantly reduces Visual Analogue Pain Score up to a year, however, the reduction in pain plateaus around six months.Disability index score only reduces for first 6 months but doesn’t significantly reduce from six months to one year.Keywords: Lumbar; radiculopathy; selective nerve root block; steroid.

scholarly journals The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy

2012 ◽  
Vol 6 (4) ◽  
pp. 227 ◽  
Author(s):  
Jae-Yoon Chung ◽  
Ji-Hyeon Yim ◽  
Hyoung-Yeon Seo ◽  
Sung-Kyu Kim ◽  
Kyu-Jin Cho
Keyword(s):  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Fluoroscopic Guidance ◽  
Nerve Root Block ◽  
Selective Nerve Root Block

scholarly journals Selective extraforaminal nerve root block for management of lumbar radiculopathy

2021 ◽  
Vol 9 (3) ◽  
pp. 147-154
Author(s):  
Vihar SJ ◽  
Naveen DS ◽  
Agrawal NK
Keyword(s):  
Nerve Root ◽  
Therapeutic Modality ◽  
Lumbar Radiculopathy ◽  
Factors Affecting ◽  
Nerve Root Block ◽  
Medical College ◽  
Vas Score ◽  
Post Procedure ◽  
Vas Scores ◽  
Selective Nerve Root Block

Lower back pain with radiculopathy is one of the common complaints that patient presents to an orthopaedician. Study was done to assess effect of extraforaminal Selective Nerve Root Block (SNRB) in management of lumbar radiculopathy in 50 patients between December 2019 and June 2020 at Bapuji Medical College and Chigateri General Hospital, Davanagere, Karnataka, India. Extraforaminal SNRB was performed and Visual Analogue Scale (VAS) scores recorded pre procedure, immediate post procedure, one month and 6 months post procedure. Significant decrease (p<0.001) in VAS scores immediate post procedure by 5 or more points in 25%; by 3-4 points in 44% and 1-2 points in 6% of the patients obtained. One month post procedure showed statistically significant results (p<0.005) owing to change in VAS score by 1-2 points in 84% (42) patients and no change or increase in the VAS scores only in 10%(5) patients. VAS scores at 6th month showed statistically significant results (p<0.005) with reduction of VAS scores in 46.34% (19), retention of VAS score 0 in 31.70% (13) and no change or increase in VAS scores in only 21.95% (9) patients. Our study concludes that extraforaminal SNRB acts as excellent diagnostic tool and therapeutic modality for immediate and long term pain management in lumbar radiculopathy. Increase in the pain scores at 6th month (p=0.2) shows that recurrence of symptoms is a possibility. Further randomized control studies with larger study population, association of patient factors affecting extraforaminal SNRB would give better insight and knowledge of the factual data.

scholarly journals The Effectiveness and Safety of Selective Lumbar Decompression in Diagnostic Doubt Patients: A Retrospective Control Study

2017 ◽  
Vol 4 (20;4) ◽  
pp. E441-E550
Author(s):  
Li Xiaochuan
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Nerve Root ◽  
Japanese Orthopaedic Association ◽  
Lumbar Surgery ◽  
Nerve Root Block ◽  
Significant Difference ◽  
Selective Nerve Root Block ◽  
Control Study ◽  
Selection Of

Background: Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure. Objective: The specific goal of this study is to compare clinical outcomes, perioperative parameters, and complications between SD and NSD procedures in DDPs. Study Design: A retrospective control study. Setting: Gaozhou People’s Hospital. Methods: From January 2009 to January 2011, 57 lumbar surgery patients with diagnostic doubt were retrospectively reviewed. Basic patient parameters, as well as perioperative and postoperative data were compared between the selective and non-selective decompression groups. Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and JOA recovery rates. Results: Both groups showed significant improvement in VAS, ODI, and JOA scores between preoperative and postoperative measurements. The differences in VAS and ODI scores between groups were not significant at 3 and 60 months postoperatively (both P > 0.05). In addition, there was no significant difference in JOA recovery rate (P = 0.659) and survival rate (P = 0.586) during the 60 months following surgery. However, distinctly superior perioperative parameters (operation time and hospital stay, blood loss and drainage volume, laminectomy numbers, and fusion segment numbers) were observed in the SD group (P < 0.001 for each score). Moreover, the SD-treated group experienced significantly fewer adverse events postoperatively (P = 0.036). Limitations: The limitations of this study lie in the size of the study and selection of patients and in the fact that it was not feasible to include all cases of diagnostic doubt. Conclusions: On the basis of the 5-year follow-up data, we suggest that the SD procedure guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure produces superior perioperative parameters when compared with the conventional NSD procedure, but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer perioperative and postoperative complications. Key words: Lumbar spinal surgery, diagnostic doubt, selective nerve root block (SNRB), selective decompression (SD)

Sign in / Sign up

Export Citation Format

Share Document