Ultrasound-guided approach for l5 dorsal ramus block and fluoroscopic evaluation in unpreselected cadavers

Manfred Greher, Bernhard Moriggl, Philip W H Peng, Cristina E. Minella, Michela Zacchino, Urs Eichenberger

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Objectives: Medial branch blocks are frequently performed to diagnose lumbar facet-joint-mediated pain. Ultrasound guidance can increase practicability and eliminate exposure to ionizing radiation when compared with fluoroscopy. However, ultrasound-guided L5 dorsal ramus block, which, together with L4 medial branch block is necessary to anesthetize the most commonly affected facet joint L5/S1, has not been described so far. The objective of this study was to develop a technique and to evaluate its accuracy with standard fluoroscopy in unpreselected cadavers. Methods: Twenty ultrasound-guided L5 dorsal ramus block approaches were performed with a new oblique out-of-plane technique in a rotated cross-axis view bilaterally in 10 cadavers. After checking the needle position in a second perpendicular sonographic plane, the final needle position was confirmed with conventional fluoroscopy by an independent observer. Results: All cadavers had significant degenerations of the lumbar spine, and 5 of them had moderate to severe spondylolisthesis. Skin-to-target distances were 42 ±7 mm. Sixteen L5 dorsal ramus block attempts were located at the exact radiological target, 1 was slightly too lateral, and 3 were slightly too caudal (3-10 mm away). The overall success rate in unpreselected cadavers reached 80% (95% confidence interval, 56%-94%) and in the subgroup of corpses without spondylolisthesis 100% (95% confidence interval, 69%-100%). Conclusions: This is the first study to show that ultrasound-guided L5 dorsal ramus block is accurate and feasible in the absence of significant spondylolisthesis when performed with an oblique out-of-plane technique.

Original languageEnglish
Pages (from-to)713-717
Number of pages5
JournalRegional Anesthesia and Pain Medicine
Volume40
Issue number6
DOIs
Publication statusPublished - Oct 20 2015

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Cadaver
Spondylolisthesis
Fluoroscopy
Zygapophyseal Joint
Needles
Confidence Intervals
Arthralgia
Ionizing Radiation
Spine
Skin

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Ultrasound-guided approach for l5 dorsal ramus block and fluoroscopic evaluation in unpreselected cadavers. / Greher, Manfred; Moriggl, Bernhard; Peng, Philip W H; Minella, Cristina E.; Zacchino, Michela; Eichenberger, Urs.

In: Regional Anesthesia and Pain Medicine, Vol. 40, No. 6, 20.10.2015, p. 713-717.

Research output: Contribution to journalArticle

Greher, Manfred ; Moriggl, Bernhard ; Peng, Philip W H ; Minella, Cristina E. ; Zacchino, Michela ; Eichenberger, Urs. / Ultrasound-guided approach for l5 dorsal ramus block and fluoroscopic evaluation in unpreselected cadavers. In: Regional Anesthesia and Pain Medicine. 2015 ; Vol. 40, No. 6. pp. 713-717.
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