The Use Of Ultrasonography In Selective Lumbar Nerve Root Injection For Treatment Of Radicular Pain

Abstract

Lumbar radicular pain also known as sciatica in the past, is a very common condition with high impact on patients’ lives, its precise definition is not clearly understood, radicular pain definition is based on its mechanism as pain evoked by stimulation of the sensory (dorsal) root of a spinal nerve or its dorsal root ganglion (DRG). The morphological pattern of the herniated disc plays an important role in LRP and is correlated strongly with the clinical picture, prognosis, and suitable treatment strategy. Chronic radicular pain is not merely an extension of the acute phase. However, local, spinal and supraspinal mechanisms interplay in the development of chronic pain. Mechanical events, particularly abnormal motion or loads to neural tissues, may trigger the mechanisms of chronic pain. Local axonal injury in particular has been shown to increase excitability and spontaneous activity of the DRG neurons. Steroids have been demonstrated to have a therapeutic role, owing to their anti-inflammatory and nociceptive signal stabilising properties. Selective nerve root injection (SNRI) or trans-foraminal epidural steroid injection (TFESI) is a technique that enables precise delivery of corticosteroid and local anesthetic in close proximity to nerve root under radiological guidance, thereby optimising the therapeutic effect. With the ultrasound growing popularity as a useful diagnostic tool and as a guiding tool in lumbar spine procedures, it has been suggested that ultrasound can aid in reducing the use of fluoroscopy or replace it completely in performing selective lumbar nerve root injection.