Must we discontinue selective cervical nerve root blocks?

Hodler, Juerg; Boos, Norbert; Schubert, Martin

doi:10.1007/s00586-012-2642-z

Cited by 31 publications

(7 citation statements)

References 21 publications

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“…Similar findings have been reported by Yamauchi et al (16) that advocate the advantage of ultrasonographic guidance to perform an extraforaminal perineural injection without epidural spreading. The safety of transforaminal injections in humans has been questioned following recognition of major complications after accidental intradural or intra-arterial injections (17,26,28,29). The study was undertaken on equine cadavers so the risk of intravascular injection and arterial wall damage could not be fully tested.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography-Guided Perineural Injection of the Ramus ventralis of the 7 and 8th Cervical Nerves in Horses: A Cadaveric Descriptive Pilot Study

et al. 2020

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To describe the feasibility and dye diffusion of selective perineural injection of the 7 and 8th cervical nerve (C7 and C8) ramus ventralis under ultrasonographic guidance in horses. Study design: Prospective experimental pilot cadaver study. Animals: Four equine cadavers of similar body weight (420-480 kg) and neck conformation. Methods: Five C7 and five C8 rami were perineurally injected with a dye solution. Anatomic dissections including vertebral canal opening were conducted to confirm nerve dye staining and describe the extent of color diffusion. Results: The ramus ventralis of the spinal cervical nerves was visualized in all cadavers. All the injections were successful in staining a portion of the nerve trunk. Eight rami had a uniform transversal staining of the nerve trunk that longitudinally covered a distance >2 cm. One C7 and one C8 nerve trunk showed incomplete transversal staining with a more concentrated color on its half cranial aspect and a longitudinal coverage of <2 cm. Five injections resulted in dye extending proximally and medially into the epidural space. Volume had no appreciable effect on the extent of nerve staining. A greater proportion of epidural diffusion was found with injections done within less than one cm distally to the articular processes. All injections were considered to be selective for the targeted nerve. Conclusion and clinical relevance: Ultrasonography-guided perineural injection of C7 and C8 ramus ventralis is a feasible technique that may have multiple applications in multimodal analgesia in horses. Further clinical study will be necessary to determine the appropriate drug, dosage, and volume to inject and to confirm its usefulness.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography-Guided Perineural Injection of the Ramus ventralis of the 7 and 8th Cervical Nerves in Horses: A Cadaveric Descriptive Pilot Study

et al. 2020

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“…It showed that probable mechanisms of spinal cord injury in patients undergoing cervical, thoracic, and lumbar epidural infiltration techniques include: spinal cord infarction due to needle-induced vasospasm, the embolization of particulate steroids, the mechanical disruption of radiculomedullary arteries, and compression from an epidural abscess or hematoma are [ 2 ]. Death as well as infarction of the brain stem, cerebellum, thalamus, and spinal cord have been reported after epidural injections, either by a transforaminal or an interlaminar procedure [ 3 ].…”

Section: Letters To Editorsmentioning

confidence: 99%

Risks and Pitfalls of Epidural Injections during Management of Lumbar Disc Herniation: Few Comments

Sanie

Ghobadifar

2015

Korean J Pain

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“…1,2 Selective cervical nerve root block (SCNRB) with imaging guidance, with either conventional fluoroscopy (CF) or CT, is an intervention that has been proved effective for many patients by alleviating pain, increasing activity, improving tolerance of physical therapy, and delaying or preventing surgical intervention. 1,3,4 This procedure involves the introduction of a needle near or into the neural foraminal perineural space, inherently carrying the risk of arterial, nerve root, and spinal cord injury. 1,[4][5][6][7] Currently, CF and CT-guided SCNRBs are the most commonly available and established methods, with a trend in recent literature suggesting that CT-guided nerve blocks allow improved safety and efficacy by way of better needle tip awareness, direct visualization of the perineural space, and visualization of the vertebral and radicular arteries when using a transforaminal approach.…”

mentioning

confidence: 99%

“…1,3,4 This procedure involves the introduction of a needle near or into the neural foraminal perineural space, inherently carrying the risk of arterial, nerve root, and spinal cord injury. 1,[4][5][6][7] Currently, CF and CT-guided SCNRBs are the most commonly available and established methods, with a trend in recent literature suggesting that CT-guided nerve blocks allow improved safety and efficacy by way of better needle tip awareness, direct visualization of the perineural space, and visualization of the vertebral and radicular arteries when using a transforaminal approach. 2,7,8 However, CT-guided SCNRB may deliver a larger radiation dose to both the patient and proceduralist, 9 with CT fluoroscopy (CT/F) reported to have an increase in the incurred radiation dose over CF by 19-fold in the cervical region (an increase of the incremental dose of 49 uSv).…”

mentioning

confidence: 99%

“…10 CT guidance is also more costly, 11 may have longer procedural times, 2 and limits real-time assessment of intravascular invasion. 3,4,8 Although sparse, current literature on SCNRB reports various differences in techniques via imaging medium, approach, and needle placement. While there are proponents of different techniques and modalities, most proceduralists have developed small variations that make their approach consistent and what they believe will be efficacious and safe.…”

mentioning

confidence: 99%

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Counterpoint: Conventional Fluoroscopy-Guided Selective Cervical Nerve Root Block—A Safe, Effective, and Efficient Modality in the Hands of an Experienced Proceduralist

Ott

Pluhm

Öztürk

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The conventional fluoroscopy-guided (CF) selective cervical nerve root block (SCNRB) is being used commonly as a treatment for cervical radicular pain as well as a diagnostic tool. This study aimed to identify any major complications and determine the safety and clinical utility of CF-SCNRB performed in a university hospital and associated outpatient clinics.MATERIALS AND METHODS: Two-hundred fifty-four conventional fluoroscopy-guided selective cervical nerve root blocks were retrospectively identified from 2011 to 2018 using a radiology report search tool. Each procedure was performed by an experienced neuroradiologist performing spinal injections on a full-time basis in clinical practice. A 10-point pain scale was used for pre-and postprocedural pain-level assessment. Successful conventional, fluoroscopy-guided, selective cervical nerve root block was defined as a patient-reported pain scale reduction of at least 50% and/or alleviation of numbness or paresthesia at $2 weeks postinjection. All clinically important immediate and delayed complications were also recorded. RESULTS: Two-hundred fifty-four conventional fluoroscopy-guided selective cervical nerve root blocks were performed via an anterolateral approach with an average fluoroscopy time of 24.3 seconds for all cases. There were no aborted procedures and no major or permanent complications. There were 14 minor complications; 12 of these were periprocedural and resolved by the 2-week follow-up visit. One-hundred eighty-five patients (75.2%) reported pain improvement of .50% from baseline at 15 minutes postinjection. Overall, 172 patients (67.7%) reported .50% pain scale reduction or alleviation from paresthesia at least 2 weeks postinjection.CONCLUSIONS: Conventional fluoroscopy-guided selective cervical nerve root block is an efficacious, efficient, and safe outpatient procedure when performed by a skilled and experienced proceduralist.

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Must we discontinue selective cervical nerve root blocks?

Cited by 31 publications

References 21 publications

Ultrasonography-Guided Perineural Injection of the Ramus ventralis of the 7 and 8th Cervical Nerves in Horses: A Cadaveric Descriptive Pilot Study

Ultrasonography-Guided Perineural Injection of the Ramus ventralis of the 7 and 8th Cervical Nerves in Horses: A Cadaveric Descriptive Pilot Study

Risks and Pitfalls of Epidural Injections during Management of Lumbar Disc Herniation: Few Comments

Counterpoint: Conventional Fluoroscopy-Guided Selective Cervical Nerve Root Block—A Safe, Effective, and Efficient Modality in the Hands of an Experienced Proceduralist

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