Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
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Feasibility of Ultrasound-Guided Lumbar and S1 Nerve Root Block: A Cadaver Study

초음파 유도하 요추 및 제1천추 신경근 차단술의 타당성 연구

  • Kim, Jaewon (Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Hye Jung (Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital) ;
  • Lee, Won Ihl (Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Won, Sun Jae (Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 김재원 (가톨릭대학교 의과대학 여의도성모병원 재활의학과) ;
  • 박혜정 (국립교통재활병원 재활의학과) ;
  • 이원일 (가톨릭대학교 의과대학 여의도성모병원 재활의학과) ;
  • 원선재 (가톨릭대학교 의과대학 여의도성모병원 재활의학과)
  • Received : 2019.02.13
  • Accepted : 2019.07.29
  • Published : 2019.12.31
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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.

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