Position of dorsal root ganglia in the lumbosacral region in patients with radiculopathy.
BACKGROUND
When applying pulsed radiofrequency on dorsal root ganglia for treating chronic lower back pain, maximum efficiency can be expected when a needle is placed 1-2 cm peripheral to the dorsal root ganglion. The object of this study is to analyze images taken after adding contrast to transforaminal epidural injection, categorize root ganglia according to anatomical position, and provide a reference for efficient needle positioning in applying pulsed radiofrequency on dorsal root ganglia.


METHODS
From January 2008 to January 2009, 457 patients who visited our hospital for root pain or radiculopathy were treated with transforaminal epidural injection on the nerve roots based on the dermatome of the painful area. Anteroposterior views were taken after injection of contrast. A virtual line was made by connecting the internal and external parts of the spinal pedicle from the contrast images. Then the dorsal root ganglia were categorized as intraspinal (IS), intraforaminal (IF), or extraforaminal (EF).


RESULTS
In the fourth lumbar spine, dorsal root ganglia positions were 48% IF, 41% IS, and 6% EF. In the fifth lumbar spine, dorsal root ganglia positions were 75% IF, 10% IS, and 6% EF. In the first sacral spine, dorsal root ganglia locations were 8% IF and 83% IS.


CONCLUSIONS
Positional categorization of dorsal root ganglia according to contrast images was proven to be good anatomical references for effective radiofrequency or blocking of dorsal root ganglia.
MHS Department of Pain Medicine, Gwangju, Korea.
Hyun Seog
HS
Moon
Yeon Dong
YD
Kim
Bang Hoon
BH
Song
Young Deog
YD
Cha
Jang Ho
JH
Song
Mi Hyeon
MH
Lee
Anesthesiology. 2008 Sep;109(3):527-42
18719452
Pain Physician. 2007 Jan;10(1):185-212
17256030
Eur J Pain. 2006 Feb;10(2):171-6
16310722
Spine (Phila Pa 1976). 1984 Jan-Feb;9(1):19-22
6719253
Spine (Phila Pa 1976). 1989 Nov;14(11):1261-4
2603061
Anesthesiology. 2005 Dec;103(6):1313; author reply 1313-4
16306748
Pain. 1980 Apr;8(2):167-180
7402681
Spine (Phila Pa 1976). 1994 Jan 1;19(1):6-11
8153806