Preoperative localization for transforaminal lumbosacral nerve root blocks with a new type of orientating plate

English Keywords:Lumbar degenerative diseases  Orientating plate  Lumbosacral nerve root blocks

English Abstract:

  【Abstract】 Objectives: To discuss the effectiveness and reliability of using a new type of orientating plate for lumbar posterolateral transforaminal lumbosacral nerve root blocks. Methods: 102 patients with lumbar degenerative diseases were enrolled in the study between March 2015 and March 2016, including single-segment lumbar disc herniation in 51 cases, single-segment lumbar spinal stenosis in 42 cases, recurrence after percutaneous endoscopic lumbar discectomy in 9 cases. All patients received lumbar posterolateral transforaminal lumbosacral nerve root blocks after being divided into two groups with the random number table. Group A: 54 patients were performed with new type of orientating plate before operation, including 8 cases in L3/4 level, 28 cases in L4/5 level, 18 cases in L5/S1 level. Group B: 48 patients were performed with metal locating needle, including 8 cases in L3/4 level, 26 cases in L4/5 level, 14 cases in L5/S1 level. There were no significant differences in age, sex, operative level, conservative treatment time between the two groups(P>0.05). The preoperative fluoroscopy times, the preparation time, the puncture time, the fluoroscopy times during puncturing, the complication of operation, the VAS pain score of the punctured area 1h after operation were measured and analyzed. Results: In group A, the preparation time was 5.2±1.0min, the preoperative fluoroscopy times were 1.1±0.3, the puncture time was 9.6±2.2min and the fluoroscopy times during puncturing were 3.1±1.0, while in group B, the preparation time was 10.7±2.3min, the preoperative fluoroscopy times were 3.8±1.2, the puncture time was 16.3±3.3min, the fluoroscopy times during puncturing were 4.6±0.6, there were significant differences between group A and group B(P<0.05). There were no intraspinal hematoma, abdominal organ injury, impairment of sensory and motor functions in lower limbs between two groups. The dural puncture occurred in 1 case of group B(1/48). The subcutaneous hematoma of punctured area occurred in 4 cases of group B(4/48). There was no significant difference in the rate of complications between two groups(P>0.05). The VAS pain score of the punctured area 1h after operation was 3.4±0.5 in group A and 5.0±0.9 in group B, there was significant difference between group A and group B(P<0.05). Conclusions: For transforaminal lumbosacral nerve root blocks, preoperative location and the design of puncture track by using new type of orientating plate can reduce the preoperative fluoroscopy times, the preoperative preparation time, and help to shorten the puncture time and the fluoroscopy times during puncturing, therefore, new type of orientating plate is easy to use, reliable and effective.