Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control.
OBJECTIVE
For diagnostic lumbar medial-branch blocks, fluoroscopic guidance is considered mandatory, but this technique comes with radiation exposure. The clinical feasibility of the ultrasound-guided lumbar medial-branch block has been demonstrated. We evaluated the success rate and validity of this new method by use of fluoroscopy controls in patients previously diagnosed with lumbar facet joint-mediated pain.


METHODS
In 20 patients, 101 lumbar medial-branch blocks were performed under ultrasound guidance. The target point was the groove at the cephalad margin of the transverse process adjacent to the superior articular process. C-arm fluoroscopy was performed afterward to confirm the needle position. Pain scores were assessed by use of visual analog scale (VAS 0 to 100).


RESULTS
All 101 needles were placed in the correct lumbar segment. Ninety-six of the 101 needletips were in the correct position with a success rate of 95%. Two needles were associated with intravascular spread of the contrast dye. VAS score was reduced from 52 to 16 after the block.


CONCLUSIONS
Ultrasound-guided lumbar medial-branch blocks can be performed with a high success rate. However, to be completely independent from fluoroscopy controls, this technique requires further studies regarding the detection of intravascular spread.
Shim
Jae-Kwang
JK
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Moon
Jin-Cheon
JC
Yoon
Kyung-Bong
KB
Kim
Won-Oak
WO
Yoon
Duck-Mi
DM
D000328:Adult; D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D014463:Ultrasonography; D021801:Zygapophyseal Joint