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Ultrasound-Guided Lumbar Medial-Branch Block: A Clinical Study With Fluoroscopy Control
  1. Jae-Kwang Shim, M.D.,
  2. Jin-Cheon Moon, M.D.,
  3. Kyung-Bong Yoon, M.D.,
  4. Won-Oak Kim, M.D. and
  5. Duck-Mi Yoon, M.D.
  1. From the Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
  1. Reprint requests: Duck-Mi Yoon, M.D., Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 134 Seodaemoon-Gu Shinchon-Dong, Seoul, Korea. E-mail: dmyoon{at}


Background and Objectives: 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.

  • Facet joint
  • Low-back pain
  • Medial-branch block
  • Ultrasound

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