CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

Sutter, Reto; Pfirrmann, Christian W. A.; Zanetti, M.; Hodler, Juerg; Peterson, Cynthia

doi:10.1007/s00256-011-1288-y

Cited by 25 publications

(41 citation statements)

References 25 publications

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“…With our study we present the first long term outcomes of indirect cervical nerve root blocks. We confirm the good short term outcomes similar to the study by Sutter et al [18] and can even show further improvement of pain relief and 'patients global impression of change' with the long term results particularly in patients who did not require surgery. Although most MRI abnormalities were not associated with 'improvement' at the various post-injection time points, the specific finding of disc extrusion was predictive for the likelihood of surgical treatment.…”

Section: Discussionsupporting

confidence: 90%

“…This is due to the larger distance to the vessels including the vertebral artery with less potential for complications such as arterial dissection or injection of drugs in brain-supplying arteries. Reported complications from the traditionally used direct cervical nerve root blocks include spinal cord and brain infarction which occur by penetrating the vertebral artery, the nerve root artery [5,[8][9][10][11][12][13][14][15][16][17][18] and small arteries in the intervertebral foramen [7]. Hodler et al reported two detrimental complications after technically correct direct cervical nerve root with cervical myelopathy and complete tetraplegia as well as persisting severe deficiencies after rehabilitation [5].…”

Section: Discussionmentioning

confidence: 99%

“…That means the needle tip is far away from the vessels. This procedure is described as a safer alternative with nearly as good short term outcomes compared to the direct cervical foraminal nerve root blocks [18].…”

Section: Introductionmentioning

confidence: 99%

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Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

et al. 2015

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• Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids. • The presence of nerve root compression was a predictive finding of 'improvement'. • Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection. • There is less pain relief in patients with disc extrusions. • There are less improvement in patients with modic type I changes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

et al. 2015

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“…When MR images are unavailable for procedural planning, reschedule the injection or (117). After reports of catastrophic neurologic injuries from cervical NRBs, some investigators recommended protocol modifications (55,75,92,(118)(119)(120). Potentially safer techniques include extraforaminal needle placement, a lateral or posterior approach, digital At S1, the needle (N4) crosses the posterior S1 foramen and enters the epidural space inferior to the S1 pedicle.…”

Section: How I Do It: Spinal Injections For Pain Management Palmermentioning

confidence: 99%

“…In more than 8000 cervical, thoracic, and lumbar interventions performed by me or under my supervision, none have been complicated by hemorrhage, infection, or neurologic damage. Radiologists should recognize and tomography (CT) to guide needle placement (74)(75)(76)(77)(78)(79)(80). This preference reflects training experience, resource availability, and institutional policy.…”

Section: Risk and Risk Mitigationmentioning

confidence: 99%

Spinal Injections for Pain Management

Palmer

2016

Radiology

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Image-guided spinal injection is commonly performed in symptomatic patients to decrease pain severity, confirm the pain generator, and delay or avoid surgery. This article focuses on the radiologist as spine interventionist and addresses the following four topics relevant to the radiologist who performs corticosteroid injections for pain management: (a) the rationale behind corticosteroid injection, (b) the interaction with patients, (c) the role of imaging in procedural selection and planning, and (d) the pearls and pitfalls of fluoroscopically guided injections. Factors that contribute to the success of a pain management service include communication skills and risk mitigation. A critical factor is the correlation of clinical symptoms with magnetic resonance (MR) imaging findings. Radiologists can leverage their training in MR image interpretation to distinguish active pain generators in the spine from incidental abnormalities. Knowledge of fluoroscopic anatomy and patterns of contrast material flow guide the planning and execution of safe and effective needle placement.q RSNA, 2016

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Ultrasound‐guided and CT‐guided selective cervical nerve root injection for the treatment of cervical radicular pain: A retrospective clinical study

Bing,

Wenting,

Rong

et al. 2023

J of Clinical Ultrasound

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ObjectiveTo compare the clinical effects and safety of ultrasound (US)‐guided selective cervical nerve root injection (SCNI) and computed tomography (CT)‐guided SCNI for patients with cervical radicular pain (CRP).MethodsForty‐two CT‐guided SCNI procedures (26 eligible patients) and forty‐two US‐guided SCNI procedures (25 eligible patients) performed to treat CRP were identified from the medical record system between October 2017 and July 2021 and enrolled in the study. The numeric rating scale was used to assess pre‐ and postprocedural pain levels, and the neck disability index was used to assess the level of function. All immediate and delayed clinical complications were also recorded. The cost of each procedure and the radiation dose of the CT procedure were documented. The follow‐up data were obtained by telephone calls or outpatient visits.ResultsFive patients in the CT group and one patient in the US group were lost to follow‐up at 1 year. No procedure‐related complications were observed in either group. Significant pain relief and cervical function improvement were achieved after treatment in both the CT‐guided SCNI and US‐guided SCNI groups; however, there were no significant differences between the two groups. The average cost per CT‐guided SCNI procedure was 133.2 USD, which was higher than the cost per US‐guided SCNI procedure (42.2 USD). Meanwhile, the necessary radiation dose per patient in the CT group was 0.36 ± 0.08 mGy.ConclusionsUS‐guided SCNI and CT‐guided SCNI have similar efficacy in treating CRP, but US‐guided SCNI is radiation free and less costly than the CT‐guided procedure.

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CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

Abstract: The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods.

Cited by 25 publications

References 25 publications

Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

Spinal Injections for Pain Management

Ultrasound‐guided and CT‐guided selective cervical nerve root injection for the treatment of cervical radicular pain: A retrospective clinical study

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