952 - Erector Spinae Block for Thoracic Radiculopathy: A Case Report

Case Diagnosis: Thoracic Radiculopathy

Case Description: A 52-year-old woman presented with a past medical history of hypertension, hyperlipidemia, and obesity with thoracic back pain radiating into the right anterior abdomen superiorly and superiorly to the umbilicus. Pain began insidiously after no specific trauma and no injury. Thoracic Computed Tomography (CT) showed a disc osteophyte complex on the right with Magnetic Resonance Imaging showing (MRI) of the thoracic spine showing severe right foraminal narrowing with severe spinal canal stenosis at T9-T10. We attempted an interlaminar epidural steroid injection with no significant pain relief. We then attempted a right sided three level (T9, T10, T11) erector spinae block (ESP) under fluoroscopic guidance that achieved a 90% pain relief in both axial back pain and radicular pain. To confirm placement, we used contrast to show adequate spread throughout the erector spinae fascial plane. This resulted in a long-lasting effect with extended pain relief.

Discussions: Erector Spinae Blocks (ESP) are used for providing analgesia in patients experiencing acute or chronic back pain. The common technique used for ESP is under ultrasound and limited data is available for ESP blocks under fluoroscopy. The purpose of the block is to target the erector spinae muscle group, which is located along the spine over the transverse process. Contact is made over the transverse process and local anesthetic with or without steroids are injected for pain relief. The ESB has been demonstrated to provide pain relief by interfascial spread toward the posterior rami of spinal nerves as well as possible epidural spread.

Conclusions: ESP blocks are a relatively new technique in the realm of peri-operative management for thoracotomies, lumbar fusions, and ventral hernia repairs commonly performed using ultrasound guidance. We present a novel approach for treating thoracic radiculopathy in a patient with challenging anatomy due to body habitus through ESP using fluoroscopy guidance.