Fluoroscopic Guided Lumbar Erector Spinae (ESP) Field Blocks: A New Technique and Radiographic Analysis.

INTRODUCTION: Lumbar Erector Spinae (ESP) field blocks have become a common postoperative treatment for surgical pain. The use of long-acting medications like liposomal bupivacaine (Exparel) has become a major component of multimodal postsurgical pain control. Traditionally ESP injections have been performed using ultrasound (U/S) guidance by an anesthesiologist. Spine surgeons have begun to utilize these liposomal injections in their procedures for postoperative pain management. Our study describes a fluoroscopic guided ESP field block technique which provides reproducible muscular coverage and pain control for spine surgery. MATERIAL AND METHODS: Sixty patients undergoing single level lumbar fusion were treated preoperatively with bilateral fluoroscopically-guided lumbar erector spinae ESP field blocks with liposomal bupivacaine. We looked at 2 different injection locations involving the ESP or multifidus muscle fascial planes. The injections contained Iohexal, which was used to evaluate the coverage area of the injection. The levels of coverage were recorded, and postoperative pain control was measured immediately, postoperatively, and at 24 hours. RESULTS: Fluoroscopic field blocks at the L3-4 level were found to provide at least 4 levels of vertebral coverage rostral-caudally in both ESP and MF fascial planes. Pain was well controlled in both injection sites. CONCLUSIONS: Surgeon-administered fluoroscopic-guided ESP field blocks provided a reliable and consistent pattern of coverage with good postoperative pain control. This technique can be easily adopted by spine surgeons.

Complications of Anterior Cervical Discectomy and Fusion.

Anterior cervical discectomy and fusion (ACDF) is the most common surgery performed on the cervical spine, and the number of its cases has tripled over the last two decades. Although this intervention is typically safe and effective, it carries an inherent complication risk, which should not be underestimated. Improvements in surgical techniques and advances in interbody fusion devices and plating systems have certainly reduced the rate of postoperative morbidity, but despite such progress, surgeons need to beware consistently of the potential complications, inform the patient of their possibility, and have a management strategy as they develop. This review discusses postoperative morbidity encountered in recently reported large studies on ACDF and highlights the senior author's own single-surgeon experience with 2579 such procedures performed between 1998 and 2017. In his clinical series, which is the largest one reported to date, the overall complication rate was 7.0% (180 cases), and dysphagia (1.9% of cases), graft/hardware failures (1.3% of cases), and postoperative hematomas (0.9% of cases) were noted most frequently. Understanding of the risk and clinical impact of complications after ACDF is very important and every effort should be put on their possible avoidance and on appropriate management when they do occur.