Sonotomy of Lumbal USG Guided
Injection of Low Back Pain
(Basic Sonotomy)
DR. Dr. Rita Vivera Pane SpKFR-K, FIPP, CIPS
LOW BACK PAIN
Low back pain is defined as pain and discomfort, localised below the costal margin and
above the inferior gluteal folds, with or without leg pain.
For most patients with low back pain a thorough history taking and physical
examination are sufficient.
Extended diagnostic analysis are needed in the case of nerve root pain/radicular pain
and serious spinal pathology, respectively after identification of red flags.
Moreover, great attention has to be achieved at psychosocial factors or so called yellow
flags which increase the risk of developing chronic low back pain and long term disability
(including work loss associated with low back pain).
Normal Anatomy of Lumbal Spine
Soft Tissue Around The Spine
Phatology of Spine
MRI Lumbal (Phatology)
Sacro-illiac joint and soft
tissue around can also
make problems in low
back area and it’s
possible to do injection
in those area by
ultrasound guiding.
Algorithm of LBP
TTS
Lumbosacral Neuraxial Scanning Tips
• Prone with pillow under abdomen
• Skin marker to indicate FJ/IL levels
• Curvelinear probe
• 7-9 cm depth setting
• Appropriate depth, focus, gain and resolution
• Practice scanning on models
• Study a spine model- in water bath
Lumbosacral Neuraxial scanning Sonoanatomy
Views
1.Para-median Sagittal
2.Para-median Sagittal Oblique
3.Para- medial Sagittal TP-Trident View
4.Two Transverse views
Lumbosacral neuraxial scanning Lumbosacral neuraxial scanning
3 paramedian longitudinal view 2 transverse views
Lumbosacral neuraxial scanning
Paramedian sagittal view
Lumbosacral neuraxial scanning
Paramedian sagittal oblique view
Lumbosacral neuraxial scanning
Paramedian sagittal TP view- Trident View
Lumbosacral neuraxial scanning
Transverse Spinous Process view
Lumbosacral neuraxial scanning
Transverse Interspinous view: 2 steps sign
US-guided Lumbar Facet Joint injections and MBB
US-guided lumbar facet joint injections & MBB
US-guided lumbar MBBB - transverse IL view
US-guided lumbar facet joint Medial Branch Block
a. Example of axial probe position over L5 joint/AP
(articular Pillar) with in-plane injection technique.
b. - Arrowhead indicates needle tip at AP.
- Arrow indicates needle tip
- Asterisk indicates AP
- Spinous process labeled
a. Axial view over sacral cornu
b. Green indicates sacrococcygeal
ligament. Asterisk indicates
sacral hiatus
c. Sagital view of sacral
d. (dorsal sacrum) indicates
sacrococcygeal ligament,
asterisk indicates sacral hiatus
a. Example of sagittal probe position over
sacrum with in plane injection
technique
b. Arrowhead indicates needle tip
traversing toward sacral hiatus, arrow
indicates needle
a. Axial view of the SIJ
b. Dashed orange line outlines sacrum, dashed purple line outlines ilium,
asterisk indicates joint space,
a. Example of axial probe position over SIJ with in plane injection technique
b. Arrowhead indicates needle tip entering SIJ, arrow indicates needle, asterisk
indicaTes joint space
1. Diagnosis
History
Physical examination
Additional tests
2. Differential diagnosis
3. Treatment
- Conservative management
- Interventional management
4. Complications of interventional treatment
5. Evidence for interventional management
6. Recommendations
7. Treatment algorithm
8. Techniques
