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AJNR - American Journal of Neuroradiology

Published ahead of print on February 13, 2008
doi: 10.3174/ajnr.A0955

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Value of Diagnostic Lumbar Selective Nerve Root Block: A Prospective Controlled Study

J.S. Yeom^a, J.W. Lee^b, K.-W. Park^a, B.-S. Chang^a, C.-K. Lee^a, J.M. Buchowski^c and K.D. Riew^c

^a Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
^b Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
^c Department of Orthopaedic Surgery, Washington University, St. Louis, Mo

View larger version (119K): [in this window] [in a new window]   Fig 1. Insufficient infiltration and insufficient passage. A, Insufficient infiltration of the root, compressed by the herniated L4–5 disk. Contrast leakage lateral to the neural foramen (arrowheads) is observed. B, Insufficient passage of the injectate from a blockade by a huge herniated disk. A filling defect of contrast media by an inferiorly migrated huge paracentral disk herniation at L4–5 is observed (arrowheads).

View larger version (121K): [in this window] [in a new window]   Fig 2. Intraepineural and extraepineural injections. A, Intraepineural injection causing aggravation of the radiating pain during the procedure, resulting in a false-negative. Central feathery appearance within the tubular outline of the root (arrowheads) is observed. B, Extraepineural injection showing the root as a linear filling defect (arrowheads).

View larger version (117K): [in this window] [in a new window]   Fig 3. Overflow of injectate. A, Injectate from the unaffected L5 root spreads caudally to the affected S1 nerve root (arrowheads), causing a false-positive result. B, Injectate from the unaffected S1 root spreads cranially to the affected L5 root (arrowheads), causing a false-positive result.