Clin Pain.  2019 Dec;18(2):59-64. 10.35827/cp.2019.18.2.59.

Feasibility of Ultrasound-Guided Lumbar and S1 Nerve Root Block: A Cadaver Study

• Kim J
• Park HJ
• Lee WI
• Won SJ

• KMID: 2470348
• DOI: http://doi.org/10.35827/cp.2019.18.2.59

Abstract

OBJECTIVE
This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers. METHOD: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent.
RESULTS
The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1.
CONCLUSION
Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.

Keyword

Ultrasonography; Spinal injection; Lumbosacral Region; Spinal roots

MeSH Terms

Cadaver*
Fluoroscopy
Injections, Spinal
Lumbosacral Region
Methods
Needles
Spinal Nerve Roots
Spine
Ultrasonography
Zygapophyseal Joint