ULTRASOUND-GUIDED

LUMBAR SELECTIVE
NERVE ROOT BLOCK

GPTN
 CLINICAL PERSPECTIVES

 Diagnostic maneuver to confirm that a specific nerve root
is in fact subserving a patient’s pain symptomatology
 Diagnostic to the specific targeted root
 Therapeutic maneuver when treating radiculitis or
radiculopathy involving a single nerve root
 CLINICALLY RELEVANT ANATOMY


 The superior boundary of the lumbar epidural space is the
fusion of the periosteal and spinal layers of dura at the
foramen magnum
 The epidural space continues inferiorly to the sacrococcygeal
membrane
 The lumbar epidural space is bounded anteriorly by the
posterior longitudinal ligament and posteriorly by the
vertebral laminae and the ligamentum flavum. The vertebral
pedicles and intervertebral foramina form the lateral limits of
the epidural space.
 

The anatomy of the lumbar vertebrae and exiting nerve roots.

 The lumbar epidural space is 5 to 6 mm at LS-3 and
widens at the S-S1 level with the lumbar spine flexed.
 The lumbar epidural space contains a small amount of
fat, veins, arteries, lymphatics, and connective tissue.
The five lumbar nerve roots exit their respective
neural foramina and move anteriorly and inferiorly
away from the lumbar spine
 The goal is to place the needle just outside the neural
foramen of the affected nerve root with precise
application of local anesthetic
ULTRASOUND-GUIDED TECHNIQUE


 Proper patient position for ultrasound-guided
lumbar selective nerve root block.
 Placement of the low-frequency curvilinear
ultrasound transducer in the longitudinal plane over
the lumbar spinous process.
Longitudinal ultrasound image of the spinous
processes of the lower lumbar spine.
Once the affected level is identified on the longitudinal ultrasound
scan, the transducer is rotated 90 degrees and a transverse
ultrasound view is obtained. The spinous process is reidentified
and its image is traced anteriorly to the lamina.
Transverse ultrasound view
of the L5 vertebra.

Transverse ultrasound view of

the inferior margin of the
lamina and adjacent facet joint
 Transverse
ultrasound view of
the facet joint and
intervertebral
foramen.


Proper needle position for performing

selective lumbar nerve root block.
 COMPLICATIONS

 Trauma to the exiting lumbar nerve roots as well as
inadvertent subarachnoid, subdural, and/or epidural
injection
 Inadvertent dural puncture occurring during selective nerve
root block of the lumbar nerve roots
 Failure to recognize an unintentional dural or subdural
injection can result in immediate total spinal anesthesia with
associated loss of consciousness, hypotension, and apnea
 Use of color Doppler to identify vascular structures should
help the clinician avoid this potentially fatal complication