J Korean Orthop Assoc.  2015 Apr;50(2):107-115. 10.4055/jkoa.2015.50.2.107.

Ultrasound-Guided Intervention in Lumbar Spine

• Choi YS
• Heo JY

• KMID: 2106745
• DOI: http://doi.org/10.4055/jkoa.2015.50.2.107

Abstract

For precise diagnosis and therapeutic interventions for chronic lumbar pain, lumbar nerve block has been performed primarily by computed tomography or C-arm fluoroscopy. The use of such equipment has disadvantages in that both patient and surgeon are exposed to radiation, and it could be used in limited areas. The current role of ultrasound guidance for musculoskeletal intervention treatments has been reported. Recently, to compensate for such disadvantage and to be able to approach easily in the outpatient department, interest in ultrasound-guided lumbar nerve block is increasing, and several studies have reported relatively high success rates. However, ultrasound-guided intervention for lumbar nerve block has not been exactly described. Therefore, we conducted this review to evaluate the feasibility of ultrasound guided lumbar interventions.

Keyword

lumbar spine; ultrasonography; interventional

MeSH Terms

Diagnosis
Fluoroscopy
Humans
Nerve Block
Outpatients
Spine*
Ultrasonography

Figure

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  Figure 1 Longitudinal facet views were obtained by curved transducer for indentification of the different spinal segments (A) and the longitudinal facet view shows L3-4, L4-5 and L5-S1 facet joint (B).

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  Figure 2 Needle insertion between the superior articular process and on the upper edge of the transverse process. (A) Procedure photo. (B) Ultrasound finding at needle insertion. SP, spinous process; FJ, facet joint; TP, transverse process.

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  Figure 3 The fluoroscopy showed correct insertion of the needle for medial branch block and distribution of the contrast media (0.5 ml).

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  Figure 4 The needle for selective nerve root block was inserted at the same angle with the needle for medial branch block as short axis out of plane approach. (A) Procedure photo. (B) Ultrasound finding at needle insertion. TP, transverse process.

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  Figure 5 The position of the needles and distribution of the contrast medium was evaluated with C-arm fluoroscopy. The two arrows indicate needles for medial branch block and the two arrowheads for selective nerve root block.

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  Figure 6 The transducer was placed transversely on the sacral hiatus and checked intercornual distance, thickness of sacrococcygeal membrane, depth of caudal space. (A) Procedure photo. (B) Ultrasound finding.

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  Figure 7 The transducer was rotated 90 degrees to obtain the longitudinal view of sacral hiatus. (A) Procedure photo. (B) Ultrasound finding.

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  Figure 8 A needle was inserted to the caudal epidural space under ultrasound guidance. (A) Procedure photo.(B) Ultrasound finding at needle insertion.

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  Figure 9 Contrast media was spread into the sacral canal and Christmas-tree like appearance was observed.

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