J Korean Orthop Assoc.  2018 Aug;53(4):350-357. 10.4055/jkoa.2018.53.4.350.

Measuring Needle Angle and Depth for Lumbar Medial Branch Block Using Ultrasonography: An Evaluation of Efficiency Compared with Magnetic Resonance Imaging

• Kim C
• Shim D
• Lee S
• Woo Y
• Baek S
• Chung H

• KMID: 2419471
• DOI: http://doi.org/10.4055/jkoa.2018.53.4.350

Abstract

PURPOSE
The purpose of this study was to compare accuracy of proper needle insertion angle between magnetic resonance imaging (MRI) and ultrasonography during lumbar medial branch nerve block procedure.
MATERIALS AND METHODS
Between January 2015 and June 2016, 80 people who underwent MRI in the past 3 months with improved lumbar pain after sono-guided medial branch nerve block were enrolled for analysis (male, 39; female, 41; average age, 63.3 years). The insertion angle and depth between the spinous process and needle at each target points were measured at various levels (superior, inferior segment of each facet joints from L2-3 to L5-S1). The needle was positioned 1 cm apart from both lateral sides of the probe, locating spinous process in the middle. A comparative analysis was performed between an ultrasonography and an MRI. We determined the statistical correlation between the two methods.
RESULTS
The average differences with respect to the distance between each level on a sono-guided medial branch nerve block were 1.28±1.07 mm in L2 (7 cases), 1.27±4.26 mm in L3 (25 cases), 1.63±5.89 mm in L4 (93 cases), 1.99±4.12 mm in L5 (141 cases), and 1.51±3.87 mm in S1 (66 cases). The average differences regarding the angle of each level were 1.69°±1.34° in L2 (7 cases), 2.03°±5.35° in L3 (25 cases), 1.49°±3.42° in L4 (93 cases), −1.55°±3.67° in L5 (141 cases), and 1.86°±4.83° in S1 (66 cases). All measurements followed a normal distribution (p < 0.05), showing statistical correlation without significant difference (p < 0.05).
CONCLUSION
After measuring each level using an MRI prior to performing the procedure, a sono-guided lumbar medial branch nerve block can be performed with greater safety and efficacy, especially for beginners.

Keyword

spine; facet joint; ultrasonography; magnetic resonance imaging

MeSH Terms

Female
Humans
Magnetic Resonance Imaging*
Needles*
Nerve Block
Spine
Ultrasonography*
Zygapophyseal Joint

Figure

• 

  Figure 1 (A) When longitudinal axis is a line along the spinous process (A-1) and center of probe is on the spinous process (A-2), entrance points of the needle are 1 cm from both lateral sides of the probe (A-3). (B) Facet joint seen at a longitudinal view; the exact point is set by counting the interface between spinous process and facet joint and upper portion of sacrum (B-1) facet joint and spinous process are checked after rotating the probe 90° for a horizontal view (B-2). S, spinous process; F, facet; T, transverse process.

• 

  Figure 2 Needle is inserted through the index at each level, needle's depth and angle between the needle and spinous process are measured when the needle touches the target point of the medial branch block.

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  Figure 3 On a magnetic resonance imaging, the length (depth) and angle of the needle at each level are measured using the distance between the entrance point of needle insertion and the target point when interface between the transverse process and superior articular process is observed on the axial view.

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