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LUMBAR SELECTIVE
NERVE ROOT BLOCK
GPTN
CLINICAL PERSPECTIVES
Diagnostic maneuver to confirm that a specific nerve root
is in fact subserving a patient’s pain symptomatology
Diagnostic to the specific targeted root
Therapeutic maneuver when treating radiculitis or
radiculopathy involving a single nerve root
CLINICALLY RELEVANT ANATOMY
The superior boundary of the lumbar epidural space is the
fusion of the periosteal and spinal layers of dura at the
foramen magnum
The epidural space continues inferiorly to the sacrococcygeal
membrane
The lumbar epidural space is bounded anteriorly by the
posterior longitudinal ligament and posteriorly by the
vertebral laminae and the ligamentum flavum. The vertebral
pedicles and intervertebral foramina form the lateral limits of
the epidural space.
Proper patient position for ultrasound-guided
lumbar selective nerve root block.
Placement of the low-frequency curvilinear
ultrasound transducer in the longitudinal plane over
the lumbar spinous process.
Longitudinal ultrasound image of the spinous
processes of the lower lumbar spine.
Once the affected level is identified on the longitudinal ultrasound
scan, the transducer is rotated 90 degrees and a transverse
ultrasound view is obtained. The spinous process is reidentified
and its image is traced anteriorly to the lamina.
Transverse ultrasound view
of the L5 vertebra.