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Total dorsal ramus block for the treatment of chronic low back pain: a preliminary study
Naohisa Miyakoshi1, Yoichi Shimada, Yuji Kasukawa
1Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp
Objective:
To evaluate the use of total dorsal ramus block, which blocks all three major branches (medial, intermediate, and lateral branches) of lumbar dorsal ramus, for chronic low back pain.
Methods:
Spread of local anesthetics with radiocontrast dye (total volume of 5 ml per administration) after total dorsal ramus block to the L4-L5 level was evaluated using computed tomography (CT) in patients with chronic low back pain (n=14; mean age, 71 years). In another group of patients, the effects of the total dorsal ramus block (n=21; mean age, 71 years) were compared with those of trigger point injection (n=22; mean age 73 years).
Results:
In all cases, the CT findings after total dorsal ramus block revealed the injectant spread over medial, intermediate, and lateral branches of both L3 and L4, those innervate the L4-L5 facet joint and surrounding back muscles. Significant alleviation of rest and motion pains evaluated with visual analogue scale was observed after total dorsal ramus block compared to the trigger point injection up to 7 days after the treatment (p<0.01).
Conclusions:
The results of this preliminary study show that the total dorsal ramus block procedure may sufficiently block all three branches of the lumbar dorsal ramus at the targeted level with significant pain reduction.
