Principle of lumbar spinal nerve
The goal of lumbar spinal nerve is not the complete analgesia and paralysis of lumbar spinal nerves, like preparing for surgery, but pain reduction and desensitization irritated neural structures in the lumbar motion segment. Using a posterolateral local anesthetic injection and mixed in combination with steroids is envisaged under image control in the foramino-articular region of the motion segment.
Insertion angle and guide the needle are determined by topographic and anatomical Palpationspunkte. Through a puncture and advancing the needle at a predetermined angle is always achieved safe bone contact and then probed the needle again after image control exactly in the intervertebral foramen of the lower lumbar spine
Indication: The main indication for lumbar spinal nerve represent all acute and chronic local and radicular lumbar syndrome but also irritations in the lumbar motion segment, caused by osteoporotic subsidence, Spondyloly-sen, tumor-related pain, spinal stenosis and inflammatory changes, especially in the area of the facet joint capsule speak. well to this treatment.
Here, to diffuse by means of the injection solution through the intervertebral foramen and for traversing lateral root located, namely at the point at which it is pressed at the discal plane of the intervertebral disc L5 / S1 if necessary. While the prudent advancement of the needle, especially in the final phase, by slow procedures under constant injection and aspiration can be unpleasant phenomenon around the nerve largely avoided. Upon definitive and secure needle position can be, depending on the clinical situation, a longer lasting local anesthetic (bupivacaine) or (and) add a glucocorticoid (z. B. 10 mg triamcinolone).
Effect of lumbar spinal nerve (LSPA): In spite of the application of the local anesthetic from posterolateral to meningeus achieved indirectly via the Ramus also nociceptors at the posterior longitudinal ligament, in dorsal annulus fibrosis and in the facet joint capsule. Among contrast examinations in CT is very small fractions of the injected solution to the proximal portions of the spinal nerves including both the spinal ganglion, and the communicating branch show. Only a portion of the injected solution passes through the intervertebral foramen into the epidural space.
After the paravertebral lumbar spinal nerve, the patient felt a reduction in his back and leg pain stops the hours. Under the measure comes in most cases to a pronounced feeling of relaxation with subjectively felt warming in the back and in the affected leg. With temporary short paralysis or lameness feelings in the leg can be expected in rare cases. Of course, should one make before attention and take appropriate precautions to patients.
Using special corticoids, and also last successful trials of PRP, there is a also long-lasting relief. Here, then in an overall concept there be a generalized complaint situation and surgeries can be avoided.
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