Department of Radiology, Innsbruck Medical University, Austria.
AJNR Am J Neuroradiol. 2011 May;32(5):828-31. doi: 10.3174/ajnr.A2389. Epub 2011 Feb 24.
Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT or fluoroscopic guidance. The benefits of US-guided instillation procedures have been shown in many studies. We conducted this study to simplify an US-guided approach to the lumbar spinal nerves and to assess the feasibility and preliminary accuracy by means of CT and anatomic dissection.
Ten US-guided injections at 5 different levels (L1-L5) were performed on 1 embalmed cadaver. Images in 3 sagittal/parasagittal scanning planes were obtained at each lumbar level: 1) the plane of the spinous processes, 2) the plane of the lumbar arches/zygapophyseal-joints, and 3) the plane of the transverse processes. The PAP was then defined by positioning the transducer perpendicularly over the medial part of the respective transverse processes, depicting the hyperechoic intertransverse ligament. In the "in-plane technique," spinal needles were advanced through the respective segmental intertransverse ligament. A solution consisting of a contrast agent and a pigmented dispersion was subsequently injected into the pararadicular compartment. An anatomic dissection of the specimen and CT scans were performed to verify the exact placement of the needle tips and to evaluate fluid dispersion in the punctured compartment.
CT examination confirmed that each needle tip was correctly placed within the intended compartment with sufficient contrast accumulation around the respective proximal segment of the spinal nerve. On each anatomic section, dye was identified in the correct compartment and directly around each targeted spinal nerve with needles shown in the correct position.
This modified US approach for therapeutic root injections in the lumbar spine by using the intertransverse ligament as a new anatomic landmark allows an easy and correct needle placement within the pararadicular compartment.
注射疗法在治疗下腰痛方面发挥着重要作用，迄今为止主要在 CT 或透视引导下进行。许多研究已经证明了超声引导下灌洗程序的益处。我们进行这项研究是为了简化腰椎脊神经的超声引导方法，并通过 CT 和解剖学解剖评估其可行性和初步准确性。
在 1 具防腐尸体上进行了 10 次超声引导下的 5 个不同水平（L1-L5）的注射。在每个腰椎水平获得 3 个矢状/旁矢状扫描平面的图像：1）棘突平面，2）腰椎弓/关节突关节平面，3）横突平面。然后通过将换能器垂直放置在相应的横突内侧部分来定义 PAP，描绘出高回声的椎间横韧带。在“平面内技术”中，将脊柱针穿过相应的节段椎间横韧带推进。随后将包含造影剂和着色分散体的溶液注入旁神经根间隙。对标本进行解剖和 CT 扫描，以验证针尖的确切位置，并评估穿刺部位的液体分散情况。
CT 检查证实，每个针尖都正确地放置在预期的间隙内，并且在相应的脊神经根近端有足够的对比剂积聚。在每个解剖切片上，染料都被识别在正确的间隙中，并且在每个目标脊神经周围直接识别出带有正确位置的针。
这种改良的超声方法通过使用椎间横韧带作为新的解剖标志，用于治疗性神经根注射，可在旁神经根间隙内轻松正确地放置针头。
