Fluoroscopically-Guided Superior Hypogastric Plexus Neurolysis Using a Single Needle: A Modified Technique for a Posterolateral Transdiscal Approach

Abstract

BACKGROUND: A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5.

OBJECTIVE: We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle.

STUDY DESIGN: A technical note describing interventional procedures.

SETTING: The neurosurgery department of a cancer hospital.

METHODS: The patient was placed in the prone position with a pillow beneath the iliac crest to facilitate opening of the intervertebral disc. The entry point for the needle was 7–8 cm to the left of the midline of the L45 level. The spinal needle was slightly advanced caudally toward the L5-S1 disc and at a 40° angle from the vertical plane. Using lateral fluoroscopic control, the needle was advanced beneath the inferior aspect of the facet joint. After entering the disc, the needle was then advanced until it passed the anterior annulus fibrosus of the L5S1 disc. After verifying adequate position using contrast, 3 mL of 75% ethanol was injected for neurolysis.

RESULTS: During the follow-up, the patient reported reduction of pain in the lower abdomen and quality of life was significantly improved.

LIMITATIONS: Sample size; no placebo control.

CONCLUSION: Although different approaches exist, we prefer the posterolateral transdiscal approach for superior hypogastric plexus block and neurolysis using a single needle. This technique is a valuable alternative.