Tips for Lumbar Nerve Root Injections

Lumbar nerve root (periradicular) injections are well-established in the diagnosis and management of lumbar radiculopathy, which occurs in 3-5% of people at some point in their life due to compression, inflammation, or injury to a lumbar spinal nerve root.

Here are 5 tips NYSORA’s team uses to identify the lumbar nerve. 

1. Identify the different spinal levels with a posterior paravertebral parasagittal sonogram.
2. Obtain a transverse sonogram to clearly delineate the spinous processes and adjacent structures (lamina of the vertebral arch, zygapophyseal articulations, inferior and superior facet, transverse process, and vertebral isthmus).
3. Rotate the transducer after identifying the correct level in the sagittal plane. The corresponding spinous process is traced until the lamina can be delineated. 
4. Slide laterally to visualize the facet joint space. Start from this view to identify the intervertebral foramen and corresponding spinal nerve.
5. The nerve root leaves the neuroforamen under the ligament between the transverse processes.

Sonoanatomy

Reverse Ultrasound Anatomy

Comparison of sonoanatomy and reverse ultrasound anatomy for lumbar nerve root injections.

Download the US Pain App HERE to read other tips on managing acute and chronic pain and to access the complete guide to ultrasound-guided chronic pain blocks.