LUMBAR MEDIAL

BRANCH BLOCK

GPTN
 CLINICAL PERSPECTIVES

 Diagnostic and therapeutic maneuver in painful
conditions involving the lumbar facet joint
 Acute posttrauma pain
 Acute low back pain emergencies 
 Treatment of arthritis-related facet joint pain
Facet arthrosis: oblique lumbar. A: Normal lumbar facets. Note that the joint spaces are smooth and
uniform; the articular processes are of a triangular shape. B: Lumbar facet arthrosis. Observe that the
joint spaces are narrowed and the articular processes sclerotic and altered in shape owing to
osteophytes.
Distribution of pain emanating from the lumbar facet joints
CLINICALLY RELEVANT ANATOMY

The anatomy and innervation

of the lumbar facet joints
ULTRASOUND-GUIDED TECHNIQUE


 Proper patient position for ultrasound-guided lumbar

medial branch block
2Placement of the ultrasound transducer in
the longitudinal plane to obtain a
paramedian sagittal transverse process
view to block the left-sided medial branch
nerves (Step One).
 Longitudinal ultrasound image demonstrating successive transverse
processes when performing the paramedian sagittal transverse process
view (Step One). This classic image is named the “trident sign.”
Proper longitudinal ultrasound transducer placement to obtain
paramedian sagittal articular view (Step Two)
The anatomic orientation of the longitudinally
placed curvilinear ultrasound transducer for the
paramedian sagittal articular view (Step Two)

Longitudinal ultrasound image of the paramedian

sagittal articular process view demonstrating the
articular processes (Step Two)
Longitudinal view of the lumbar facet joint. Note the
superior and inferior articular processes
Proper in-plane needle position for ultrasound lumbar intra-
articular facet injection.
LUMBAR FACET

 CLINICAL PERSPECTIVES

 Diagnostic and therapeutic maneuver in painful
conditions involving the lumbar facet joint
 Palliate acute low back pain emergencies
 Posttrauma pain
  Arthritis-related facet joint pain
Facet arthrosis: oblique lumbar. A: Normal lumbar facets. Note that the joint spaces are smooth and
uniform; the articular processes are of a triangular shape. B: Lumbar facet arthrosis. Observe that the
joint spaces are narrowed and the articular processes sclerotic and altered in shape owing to
osteophytes.
Distribution of pain emanating from the lumbar facet joints
ULTRASOUND-GUIDED TECHNIQUE

 Proper patient position for ultrasound-guided
lumbar intra-articular facet
 The anatomy and
innervation of the
lumbar facet joints
Placement of the ultrasound transducer in the
longitudinal plane to obtain a paramedian
sagittal transverse process view to perform
intra-articular facet joint block (Step One).
 Longitudinal ultrasound image demonstrating successive
transverse processes (TP) when performing the paramedian
sagittal transverse process view (Step One). This classic image is
named the “trident sign.”
Proper longitudinal ultrasound transducer placement to
obtain paramedian sagittal articular view (Step Two).
 Longitudinal ultrasound image of the
paramedian sagittal articular process view
demonstrating the articular processes
(Step Two)
 Longitudinal view of the lumbar facet joint.
Note the superior and inferior articular processes
 

 Proper in-plane needle position for ultrasound

lumbar intra-articular facet block injection
 COMPLICATIONS

 Sepsis and local infection at the injection site
represent absolute contraindications
 Trauma to the exiting lumbar nerve roots and spinal
cord
 Total spinal anesthesia
 Loss of consciousness
 Hypotension
 Apnea