Summary
To determine the reliability of lumbar nerve root sheath infiltration, a prospective study was performed. Ninety-four patients were randomized into three groups. In the first group of 33 patients, 0.5 cc of dye (Telebrix N, 30 g) was applied at nerve root L4, in the second group of 30 patients, 1.0 cc, and in the third group of 31 patients, 2.0 cc. The infiltration was quided by computer tomography. The diffusion of the dye was documented with computed tomography of the affected segment L4-5. The images were evaluated by an unbiased observer. The results showed that in the first group the dye diffused to the adjacent ipsilateral nerve roots L3 and/or L5 in nine patients. In the second and third groups this diffusion was seen in 9 and 11 patients, respectively. A diffusion into the psoas muscle was documented in 4, 10 and 22 patients, respectively. These latter differences were statistically significant (P < 0.01). Diffusion into the psoas muscle is especially important because the nerve roots converge in this muscle to become a plexus, and they are no longer surrounded by their dural sheaths. Diagnostic lumbar nerve root sheath infiltration should be performed by an experienced examiner. To guarantee high reliability, the tip of the needle should be placed as near as possible to the affected nerve root. The amount of local anaesthetic should be as small as possible, 0.5 cc or preferably less.
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References
Castro WHM, Van Akkerveeken PF (1985) Selective lumbar nerve root infiltration, a diagnostic procedure. Read at the annual meeting of the International Society for the Study of the Lumbar Spine, Sydney, Australia, April 14–19
Castro WHM, Van Akkerveeken PF (1991) Der diagnostische Wert der selektiven lumbalen Nervenwurzelblockade. Z Orthop 129:374–379
Grönemeyer DHW, Seibel RMM (1989) Interventionelle Computertomographie. Blackwell, Wien
Macnab I (1971) Negative disc exploration. An analysis of the causes of nerve root involvement in sixty eight patients. J Bone Joint Surg [Am] 53:891–903
Van Akkerveeken PF (1989) Lateral lumbar stenosis. Thesis, University of Utrecht
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Castro, W.H.M., Grönemeyer, D., Jerosch, J. et al. How reliable is lumbar nerve root sheath infiltration?. Eur Spine J 3, 255–257 (1994). https://doi.org/10.1007/BF02226574
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DOI: https://doi.org/10.1007/BF02226574