Paravertebral Collateral Arteries in Patients with Carotid Stenosis: Is There a Safe Space for Transforaminal Cervical Nerve Root Injections?

Moussa, Amr; Syed, Adeel Ejaz; Farghal, Aser; Toms, Andoni P.

doi:10.1007/s00270-019-02240-7

Cited by 1 publication

(2 citation statements)

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“…A retrospective study demonstrated that collateral arteries were present in the majority of patients with significant (> 70%) stenosis on carotid CT angiogram and were within 10 mm of the optimal needle tip position for transforaminal CESI. 118 All these findings establish that there is no specific "safe zone" for needle placement in the posterior cervical foramina during transforaminal CESI. It is still unclear whether these vascular anatomic variants or anomalies increase the risk of complications, but due to the potential for this to be the case, caution should be exercised during this procedure.…”

Section: Anatomical Considerationsmentioning

confidence: 96%

“…Special attention should be paid to patients with carotid stenosis. A retrospective study demonstrated that collateral arteries were present in the majority of patients with significant (> 70%) stenosis on carotid CT angiogram and were within 10 mm of the optimal needle tip position for transforaminal CESI 118 . All these findings establish that there is no specific “safe zone” for needle placement in the posterior cervical foramina during transforaminal CESI.…”

Section: Side Effects and Complications Of Interventional Pain Manage...mentioning

confidence: 99%

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2. Cervical radicular pain

et al. 2023

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IntroductionCervical radicular pain is pain perceived in the upper limb, caused by irritation or compression of a cervical spine nerve, the roots of the nerve, or both.MethodsThe literature on the diagnosis and treatment of cervical radicular pain was retrieved and summarized.ResultsThe diagnosis is made by combining elements from the patient's history, physical examination, and supplementary tests. The Spurling and shoulder abduction tests are the two most common examinations used to identify cervical radicular pain. MRI without contrast, CT scanning, and in some cases plain radiography can all be appropriate imaging techniques for nontraumatic cervical radiculopathy. MRI is recommended prior to interventional treatments. Exercise with or without other treatments can be beneficial. There is scant evidence for the use of paracetamol, nonsteroidal anti‐inflammatory drugs, and neuropathic pain medications such as gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants for the treatment of radicular pain. Acute and subacute cervical radicular pain may respond well to epidural corticosteroid administration, preferentially using an interlaminar approach. By contrast, for chronic cervical radicular pain, the efficacy of epidural corticosteroid administration is limited. In these patients, pulsed radiofrequency treatment adjacent to the dorsal root ganglion may be considered.ConclusionsThere is currently no gold standard for the diagnosis of cervical radicular pain. There is scant evidence for the use of medication. Epidural corticosteroid injection and pulsed radiofrequency adjacent to the dorsal root ganglion may be considered. [Correction added on 12 June 2023, after first online publication: The preceding sentence was corrected.]

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Section: Anatomical Considerationsmentioning

confidence: 96%

Section: Side Effects and Complications Of Interventional Pain Manage...mentioning

confidence: 99%