Ultrasound-Guided Injections in the Lumbar and Sacral Spine

Kwang Pyo Ko; Jae Hwang Song; Whoan Jeang Kim; Sang Bum Kim; Young Ki Min

doi:10.4184/jkss.2018.25.4.185

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Ko, Song, Kim, Kim, and Min: Ultrasound-Guided Injections in the Lumbar and Sacral Spine

Review Article

Journal of Korean Spine Surg 2018;25(4):185-195.

Published online: 31 December 2018

DOI: https://doi.org/10.4184/jkss.2018.25.4.185

Ultrasound-Guided Injections in the Lumbar and Sacral Spine

Kwang Pyo Ko, M.D., Ph.D.^∗, Jae Hwang Song, M.D., Whoan Jeang Kim, M.D., Ph.D.^†, Sang Bum Kim, M.D., Young Ki Min, M.D.

^∗Hanmaeum Orthopaedic Clinic, Daejeon, Korea

Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Korea

^†Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea

Corresponding author: Jae Hwang Song, M.D. ORCID ID: Kwang Pyo Ko: https://orcid.org/0000-0001-8992-598X Jae Hwang Song: https://orcid.org/0000-0001-5192-4965 Whoan Jeang Kim: https://orcid.org/0000-0002-1263-4567 Sang Bum Kim: https://orcid.org/0000-0002-3554-9912 Sang Jin Jeong: https://orcid.org/0000-0002-4998-8481 Department of Orthopedic Surgery, Konyang University Hospital 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Korea TEL: +82-42-600-6902, FAX: +82-42-600-9793 E-mail: songjajj@daum.net

Received 27 July 201817 August 2018 Accepted 17 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Literature review.

Objective

Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine.

Summary of Literature Review

Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method.

Materials and Methods

We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine.

Results

In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance.

Conclusions

Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

Keywords: Lumbar, Sacral, Ultrasound-guided Injection

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Fig. 1.

The surface anatomy of the lumbosacral area is shown. A is the line between both iliac crests (Tuffier's line), corresponding to the lower margin of the fourth spinous process and the upper margin of the fifth vertebral body. B is the interspinous process line. C is the line between both posterior superior iliac spines (PSIS). The C line is the level of the S2 body. D is the vertical line from the PSIS. E is the line bisecting B and D. F is the facet joint that is the cross-point of A and E. The S1 foramen is located at the superolateral aspect of the cross-point between C and E. SH: Sacral hiatus. IS: Ischial spine. IT: Ischial tuberosity. GMe: Gluteus medius.

Fig. 2.

Longitudinal spinal sonographic view. (A) A sonogram showing the laminas. The lamina resembles a sawtooth. (B) A longitudinal interlaminar view showing the ligamentum flavum, dural space, and posterior cortex of the vertebral body (arrows). (C) The facet joint resembles a camel hump. (D) The transverse process resembles a trident. The psoas major muscle is located between the transverse processes. L: Lamina. T: Transverse process.

Fig. 3.

Transverse spinal sonographic view. (A) The transverse view shows the spinous process (S), facet joint (F), and transverse process (T). (B) A transverse interspinous process view showing the dural space and posterior cortex of the vetebral body.

Fig. 4.

Transverse view of medial branch block and facet joint block. (A) Medial branch block is shown. The needle is located between the transverse process and the superior articular process. SP: Spinous process, TP: Transverse process, F: Facet joint. (B) A facet joint intra-articular injection is shown.

Fig. 5.

A transvere view of the lumbar vertebra is shown. The arrow indi-cates the target for the injection. SP: spinous process. L: lamina. V.body: verterbral body.

Fig. 6.

A caudal epidural block is shown. (A) Malposition of the needle is shown. The needle is located above the sacrum. (B) The needle is located in the caudal canal, but the tip of the needle is not observed.

Fig. 7.

Periradicular and pararadicular block. (A) The periradicular approach is shown. (B) The pararadicular approach is shown. SP: spinous process. L: lamina. V.body: vertebral body. TP: transverse process.

Fig. 8.

L5-S1 selective nerve root block. (A) A gross image of L5 nerve root block is shown. (B) The L5 nerve root block approach is shown. (C) A gross image of S1 foramen block is shown. (D) S1 foramen block is shown.

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