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Related Experiment Videos

How reliable is lumbar nerve root sheath infiltration?

W H Castro1, D Grönemeyer, J Jerosch

  • 1Orthopädische Klinik, Westfälische Wilhelms-Universität, Münster, Germany.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|January 1, 1994
PubMed
Summary

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Lumbar nerve root sheath infiltration reliability was studied. Smaller dye volumes (0.5 cc) reduced diffusion into the psoas muscle, improving diagnostic accuracy for nerve root blocks.

Area of Science:

  • Radiology
  • Anesthesiology
  • Neurosurgery

Background:

  • Lumbar nerve root sheath infiltration is a diagnostic procedure.
  • Reliability of this technique depends on accurate dye spread.
  • Understanding dye diffusion patterns is crucial for effective nerve root blocks.

Purpose of the Study:

  • To evaluate the reliability of lumbar nerve root sheath infiltration.
  • To determine the optimal volume of contrast dye for accurate nerve root targeting.

Main Methods:

  • A prospective study involving 94 patients randomized into three groups.
  • Dye (Telebrix N, 30 g) injected at L4 nerve root with volumes of 0.5 cc, 1.0 cc, and 2.0 cc.
  • Computer tomography (CT) guided injections and CT imaging documented dye diffusion.

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Main Results:

  • Dye diffusion to adjacent nerve roots (L3/L5) occurred in 9-11 patients across groups.
  • Significant increase in psoas muscle dye diffusion with larger volumes (4, 10, 22 patients; P < 0.01).
  • Psoas muscle diffusion is critical as nerve roots lose dural sheath protection.

Conclusions:

  • Smaller dye volumes (0.5 cc) minimize unwanted diffusion, enhancing reliability.
  • Accurate needle placement near the target nerve root is essential.
  • Experienced examiners and minimal local anesthetic volume improve diagnostic accuracy.