Joint and Sacral Lateral Branch Blocks


Fig. 15.1

Illustration of the posterior sacral ligaments: posterior superior iliac spine (1); iliolumbar ligament (2); interosseous and dorsal sacroiliac ligaments (3); sacrotuberous ligament (4); sacrospinous ligament (5). (Reprinted with permission from Dr. Danilo Janovic)



Patient Selection


The SIJ plays a causative role in up to 30% of patients with chronic low back pain. Afflicted patients will typically have back pain below the L5 level with radiation to the buttocks or lower extremities. Provocative physical exam tests can be used to identify likely candidates, and the findings of 3 or more positive tests have been found to have a modest predictive power (sensitivity 91%, specificity 78%) in relation to controlled comparative SIJ blocks. Key tests include distraction, compression, thigh thrust, Gaenslen’s, sacral thrust, and Patrick’s FABER. However, their ability to detect posterior complex pain has not been evaluated.


Ultrasound Scanning






  • Probe: C5-2 MHz curved transducer.



  • Position: prone


Transverse Plane Scan


This is the primary view for procedures targeting the SIJ. Accurate identification of the various landmarks depends on a methodical scan which begins at the sacral hiatus and progresses cephalad to the posterior S1 foramen (Fig. 15.2).

../images/457420_1_En_15_Chapter/457420_1_En_15_Fig2_HTML.jpg

Fig. 15.2

Sonographic images of the posterior sacrum depicting the various views required for the performance of an ultrasound-guided sacral lateral branch block. The three injection points on the sacral lateral crest are marked by a star (★); probe placement on the skin surface is illustrated in the upper left inset of panel (a); scan lines are illustrated on a skeletal model in the left lower insets. (a) transverse sonographic view of the lower sacrum demonstrating the sacral cornu (SC) and posterior foramen of S4 (S4); (b) sacral cornu (SC), posterior foramen of S3 (S3), lateral sacral crest (LSC); (c) median sacral crest (MSC), lateral sacral crest (LSC), yellow star indicates injection target; (d) median sacral crest (MSC), posterior foramen of S2 (S2), lateral sacral crest (LSC), black arrow indicates caudal aspect of sacroiliac joint; (e) median sacral crest (MSC), lateral sacral crest (LSC), yellow star indicates injection target; (f) median sacral crest (MSC), posterior foramen of S1 (S1), yellow star indicates injection target, posterior superior iliac spine (PSIS). (Reprinted with permission from Philip Peng Educational Series)


Sagittal Plane Scan


This view is used for needle placement verification during SLB block procedures (Fig. 15.3).

../images/457420_1_En_15_Chapter/457420_1_En_15_Fig3_HTML.jpg

Fig. 15.3

Parasagittal scan of the sacrum demonstrating the posterior sacral foramen. This view is used to confirm needle placement. Probe placement on the skin surface is illustrated in the upper left inset. The posterior foramen of S1, S2, and S3 are visible. (Reprinted with permission from Philip Peng Educational Series)

Only gold members can continue reading. Log In or Register to continue

Oct 20, 2020 | Posted by in ANESTHESIA | Comments Off on Joint and Sacral Lateral Branch Blocks
Premium Wordpress Themes by UFO Themes