Fluoroscopy-guided approach to the lumbar dorsal root ganglion in dogs: cadaver study in Beagles

Abstract

Objective To evaluate an approach to the canine lumbar dorsal root ganglion (DRG), a significant contributor to the pain pathway, using new methylene blue staining. Study design Prospective randomized study. Animals A total of three Beagle dog cadavers weighing 10.4 +/- 0.7 kg (mean +/- standard deviation). Methods Bilateral third to fifth lumbar DRG approaches were performed in three dog cadavers positioned in sternal recumbency. The mammillary process was palpated, and a 22 gauge spinal needle was inserted through the skin 1 cm lateral to the process and directed towards the median plane at a 45 degrees angle to the dorsal plane. The needle was advanced along the transverse plane until touching bone, or a popping sensation was detected. Under fluoroscopic guidance, the position of the needle tip was adjusted to be in the cranioventral part of the intervertebral foramen. The location of the needle was confirmed by demarcation of the nerve roots after iohexol (0.1 mL) injection. For evaluation of the DRG approach, new methylene blue (0.1 mL) was injected. Subsequently, anatomical dissection of the area was performed. The DRG staining was scored as follows: 0, no staining; 1, partial (<50%); 2, partial (>= 50%); and 3, complete staining. Comparisons among the staining scores of the third to fifth DRG were assessed with the Friedman test. Results Staining score 3 was achieved in 14 of 18(77.8%) sites. Staining scores 2, 1 and 0 were identified at two, one and one of the 18 sites, respectively. No significant difference was noted in the staining scores among the third to fifth DRGs (p = 0.78). Conclusions and clinical relevance The technique used for DRG injections achieved adequate DRG staining, supporting use of the fluoroscopy-guided approach to the canine lumbar DRG.