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26-07-2023 | Nerve Block | Review Article

Selective MR neurography–guided lumbosacral plexus perineural injections: techniques, targets, and territories

Authors: Danoob Dalili, Amanda Isaac, Jan Fritz

Published in: Skeletal Radiology | Issue 10/2023

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Abstract

The T12 to S4 spinal nerves form the lumbosacral plexus in the retroperitoneum, providing sensory and motor innervation to the pelvis and lower extremities. The lumbosacral plexus has a wide range of anatomic variations and interchange of fibers between nerve anastomoses. Neuropathies of the lumbosacral plexus cause a broad spectrum of complex pelvic and lower extremity pain syndromes, which can be challenging to diagnose and treat successfully. In their workup, selective nerve blocks are employed to test the hypothesis that a lumbosacral plexus nerve contributes to a suspected pelvic and extremity pain syndrome, whereas therapeutic perineural injections aim to alleviate pain and paresthesia symptoms. While the sciatic and femoral nerves are large in caliber, the iliohypogastric and ilioinguinal, genitofemoral, lateral femoral cutaneous, anterior femoral cutaneous, posterior femoral cutaneous, obturator, and pudendal nerves are small, measuring a few millimeters in diameter and have a wide range of anatomic variants. Due to their minuteness, direct visualization of the smaller lumbosacral plexus branches can be difficult during selective nerve blocks, particularly in deeper pelvic locations or larger patients. In this setting, the high spatial and contrast resolution of interventional MR neurography guidance benefits nerve visualization and targeting, needle placement, and visualization of perineural injectant distribution, providing a highly accurate alternative to more commonly used ultrasonography, fluoroscopy, and computed tomography guidance for perineural injections. This article offers a practical guide for MR neurography–guided lumbosacral plexus perineural injections, including interventional setup, pulse sequence protocols, lumbosacral plexus MR neurography anatomy, anatomic variations, and injection targets.
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Metadata
Title
Selective MR neurography–guided lumbosacral plexus perineural injections: techniques, targets, and territories
Authors
Danoob Dalili
Amanda Isaac
Jan Fritz
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Keyword
Nerve Block
Published in
Skeletal Radiology / Issue 10/2023
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-023-04384-7

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