• Noritaka Suzuki, Toshiaki Kotani, Takahiro Sunami, Kotaro Sakashita, Shun Okuwaki, Shuhei Ohyama, Shuhei Iwata, Yasushi Iijima, Tsuyoshi Sakuma, Tsutomu Akazawa, Kazuhide Inage, Yasuhiro Shiga, Shohei Minami, and Seiji Ohtori.
• Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
• World Neurosurg. 2024 Jan 1; 181: e459e467e459-e467.

ObjectiveThe first sacral nerve root block (S1 NRB) is used to diagnose and treat lumbosacral and radicular pain. This study aims to clarify the anatomy of the S1 neural foramen using three-dimensional (3D) computed tomography (CT) images and to establish the optimal fluoroscopic angle, localize the S1 neural foramen on fluoroscopy, and determine the safe puncture depth for S1 NRB.MethodsIn this single-center cohort study, 200 patients with lumbar degenerative disease who underwent preoperative CT were enrolled. Four distinct studies were conducted using the CT data. Study 1 examined the correlation of the sacral slope angle and the supine and prone positions. Study 2 analyzed the tunnel view angle (TVA) using 3D reconstruction. Study 3 ascertained the location of the S1 neural foramen in fluoroscopy images. Study 4 investigated the safe depth for performing S1 NRB.ResultsThe regression analysis in Study 1 revealed a correlation of the sacral slope angle and the supine and prone positions. Study 2 determined an optimal fluoroscopic TVA of approximately 30° for the S1 NRB. Study 3 found that the S1 neural foramen was located caudal to the L5 pedicle 1.7 ± 0.2 times the distance between the L4 and L5 pedicles. Study 4 revealed that the depths of the S1 neural foramen and root were 27.0 ± 2.1 mm and 16.5 ± 2.0 mm, respectively.ConclusionsOur study suggests an optimal fluoroscopic angle, a simple method to locate the S1 neural foramen on fluoroscopy, and an ideal puncture depth for a safe and effective S1 NRB.Copyright © 2023 Elsevier Inc. All rights reserved.

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