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. 2017 Apr 21;96(16):e6655. doi: 10.1097/MD.0000000000006655

Figure 1.

Figure 1

Ultrasound-guided medial branch block. (A) Long-axis view of the lumbar spine showing the L5 spinous process and median S1 crest (SC). (B) Long-axis view of the lumbar spine with L4/L5 and L5/S1 facet joint contours and the S1 (arrow) dorsal foramen. (C) Long-axis view showing the L4 and L5 transverse processes and the sacral ala (SA). Upper edge of the transverse process, or the sacral ala, immediately lateral to the superior articular process is the correct anatomical target (arrow). (D) Short-axis view of the sacrum showing the S1 median crest (arrow head) and the surface of the sacrum (arrow). (E) Short-axis view of L4/L5 segment showing the interspinous ligament (ISL), L5 superior articular process (SAP), and L4 transverse process (TP). Target point on between the L5 superior articular process (SAP) and the L4 transverse process for an approach toward the right-sided L4 medial branch (arrow). (F) Short-axis view of the lumbosacral segment showing the interspinous ligament (ISL), S1 superior articular process (SAP), the sacral ala (SA), and the iliac crest (IC). Target point is between the S1 superior articular process (SAP) and the sacral ala for an approach to the right-sided L5 dorsal ramus (arrow).