DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES: Postlaminectomy syndrome, lumbar facet syndrome, lumbar radiculopathy.
POSTOPERATIVE DIAGNOSES: Postlaminectomy syndrome, lumbar facet syndrome, lumbar radiculopathy.
PROCEDURE PERFORMED: Right lumbar medial branch block of L3-4, L4-5, and L5-S1.
DESCRIPTION OF PROCEDURE: After signing informed consent, the patient was brought to the operating room for right lumbar medial branch block of L3-4, L4-5, and L5-S1 and placed in a prone position on the operating room table. The lower back was prepped and draped in a sterile fashion on the right side. The right sacral ala was identified with an AP fluoroscopic view. A 25-gauge, 3-1/2 inch Quincke spinal needle was inserted, gun barrel fashion, and directed downward until the tip made bony contact at the sacral ala. Aspiration was negative for blood or CSF. A mixture of 1 mL of 0.5% bupivacaine and 10 mg of Depo-Medrol was injected at this site. The needle was removed. Attention was turned to the L4-5 medial branch nerve location located at the proximal SAP and eye of the scotty dog. The same 3-1/2 inch Quincke spinal needle was inserted, gun barrel fashion, and directed downward until the tip made bony contact at the eye of the scotty dog. Aspiration was negative for blood or CSF. The same mixture of medication was injected at this site. Attention was turned to the L3-4 medial branch nerve site and the exact same technique and medication was used to perform the medial branch nerve block for the L3-4. All needles were removed at the end of the procedure. Sterile bandage was placed. The patient was brought to the recovery area and discharged home that day.
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Cervical facet syndrome, cervical radiculopathy.
POSTOPERATIVE DIAGNOSIS: Cervical facet syndrome, cervical radiculopathy.
PROCEDURE PERFORMED: Right cervical medial branch block of C4-5, C5-6, and C6-7.
DESCRIPTION OF PROCEDURE: After signing informed consent, the patient was brought to the fluoroscopy suite for right cervical medial branch block of C4-5, C5-6, and C6-7 and placed in a prone position on the fluoroscopy table. The cervical area was prepped and draped in a sterile fashion. Using AP fluoroscopic guidance, the cervical transverse process was identified corresponding with the right C4-5, C5-C6, and C6-7. At transverse process C5, the Quincke spinal needle was placed and advanced until the tip made bony contact to the lateral aspect. Aspiration was negative for blood or CSF. A mixture of 2 mg of Celestone plus 0.5 mL of 0.5% bupivacaine with 2% lidocaine mixed 1:1, both preservative free, was injected at this location. The needle was withdrawn slightly and redirected to cephalad until it made bony contact at the transverse process of C4 and exact same medication was injected following negative aspiration for blood or CSF. The needle was withdrawn again slightly and then redirected caudally until the tip made bony contact to C5-6 medial branch nerve location. Again, the same medication was injected following a negative aspiration for blood or CSF. Needle was removed. Sterile bandage was placed. The patient did note some improvement of range of motion immediately following the procedure. She was brought to the recovery area and discharged home without incident.
