Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Konkret geht es um den Diabetes-Patienten mit kardiovaskulären Erkrankungen oder Risiken, die Herzinsuffizienz sowie die kardiovaskuläre Primär- und Sekundärprävention. Sind Sie hier schon auf dem neuesten Stand? Unsere Experten beleuchten, wo und warum das bisherige Procedere geändert werden soll und was in der Praxis sinnvoll ist. Holen Sie sich Ihr Update und 2 CME-Punkte beim MMW-Webinar am 24. April von 17.30 bis 19 Uhr. 
Erweiterte Suche
Anmelden
nach oben
Current Pain and Headache Reports
Erschienen in: Current Pain and Headache Reports 2/2013

01.02.2013 | Anesthetic Techniques in Pain Management (KA Williams, Section editor)

Cervical Epidural Steroid Injections for the Treatment of Cervical Spinal (Neck) Pain

verfasst von: Kenneth D. Candido, Nebojsa ‘Nick’ Knezevic

Erschienen in: Current Pain and Headache Reports | Ausgabe 2/2013

Einloggen, um Zugang zu erhalten

Abstract

Cervical epidural steroid injections (CESI) are an accepted treatment for neck pain with a radicular component, and may be accomplished by using either transforaminal (CTFESI) or interlaminar (CILESI) approaches. CESIs are routinely performed using real-time fluoroscopic-guidance in conjunction with the injection of water soluble, iodine-based contrast media to enhance visualization of intravascular injections. Digital subtraction angiography (DSA) imaging is an adjuvant to fluoroscopic methods for visualizing blood vessels while performing spinal injections. However, as with any neuraxial procedure, various complications associated with CESIs have been reported. Complications are directly associated with the technical procedures of CESIs. Particulate steroids may have a prolonged duration of action but non-particulate steroids are safer for CESIs. Blunt-beveled needles are less likely than sharp-beveled needles to penetrate blood vessels to cause bleeding complications during CTFESI procedures. Small doses of local anesthetics appear to be safe and assist in identifying intravascular injections previously overlooked by conventional techniques.
Literatur
1.
Thierry-Mieg J. Cervical epidural injections of corticoids in hyperalgic cervico-brachial neuralgias. 1st cervical epidurographical pictures. Rev Rhum Mal Osteoartic. 1961;28:451–3.PubMed
2.
Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of a traumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000;81:741–6.PubMed
3.
•• Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699–802. A systematic literature review of different interventional techniques used in the treatment of chronic spinal pain, including the cervical (neck) pain.PubMed
4.
Stout A. Epidural steroid injections for cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011;22:149–59.PubMedCrossRef
5.
Kang JD, Georgescu HI, McIntyre-Larkin L, Stefanovic-Racic M, Evans CH. Herniated cervical intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine. 1995;20:2373–8.PubMedCrossRef
6.
• Lee SH, Kim KT, Kim DH, Lee BJ, Son ES, Kwack YH. Clinical outcomes of cervical radiculopathy following epidural steroid injection: a prospective study with follow-up for more than 2 years. Spine. 2012;37:1041–7. Prospective clinical study analyzing the effects of CILESI and CTFESI in the treatment of cervical radiculopathy with long follow up (more than 2 years).PubMedCrossRef
7.
Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology. 2004;100:1595–600.PubMedCrossRef
8.
Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004;4:468–74.PubMedCrossRef
9.
Han KR, Kim C, Park SK, Kim JS. Distance to the adult cervical epidural space. Reg Anesth Pain Med. 2003;28:95–7.PubMed
10.
• Botwin KP, Castellanos R, Rao S, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil. 2003;84:627–33. Retrospective study assessing the incidence of complications of fluoroscopically-guided CILESIs.PubMed
11.
Goodman B, Petalcorin JS, Mallempati S. Optimizing patient positioning and fluoroscopic imaging for the performance of cervical interlaminar epidural steroid injections. Pm R. 2010;2:783–6.PubMedCrossRef
12.
Lirk P, Kolbitsch C, Putz G, et al. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology. 2003;99:1387–90.PubMedCrossRef
13.
Goel A, Pollan JJ. Contrast flow characteristics in the cervical epidural space: an analysis of cervical epidurograms. Spine. 2006;31:1576–9.PubMedCrossRef
14.
Wolter T, Knoeller S, Berlis A, Hader C. CT-guided cervical selective nerve root block with a dorsal approach. AJNR: Am J Neuroradiol. 2010;31:1831–6.PubMedCrossRef
15.
Wald JT, Maus TP, Geske JR, et al. Safety and efficacy of CT-guided transforaminal cervical epidural steroid injections using a posterior approach. AJNR Am J Neuroradiol. 2012;33:415–9.PubMedCrossRef
16.
Anderberg L, Annertz M, Brandt L, Saveland H. Selective diagnostic cervical nerve root block–correlation with clinical symptoms and MRI-pathology. Acta Neurochir. 2004;146:559–65.CrossRef
17.
Manchikanti L. The growth of interventional pain management in the new millennium: a critical analysis of utilization in the Medicare population. Pain Physician. 2004;7:465–82.PubMed
18.
• Jee H, Lee JH, Kim J, Park KD, Lee WY, Park Y. Ultrasound-guided selective nerve root block vs fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: a randomized, blinded, controlled study. Skeletal Radiol. 2013;42:69–78. Prospective clinical study comparing short-term effect and advantages of ultrasound-guided SCNRBs and fluoroscopically-guided CTFESIs.
19.
Siegenthaler A, Mlekusch S, Trelle S, Schliessbach J, Curatolo M, Eichenberger U. Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints. Anesthesiology. 2012;117:347–52.PubMedCrossRef
20.
Tofuku K, Koga H, Komiya S. Subdural spread of injected local anesthetic in a selective transforaminal cervical nerve root block: a case report. J Med Case Rep. 2012;6:142.PubMedCrossRef
21.
Galiano K, Obwegeser AA, Walch C, Schatzer R, Ploner F, Gruber H. Ultrasound-guided vs computed tomography-controlled facet joint injections in the lumbar spine: a prospective randomized clinical trial. Reg Anesth Pain Med. 2007;32:317–22.PubMed
22.
Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar vs transforaminal. A review. Curr Rev Musculoskelet Med. 2009;2:30–42.PubMedCrossRef
23.
Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. Complications of fluoroscopically directed facet joint nerve blocks: a prospective evaluation of 7500 episodes with 43,000 nerve blocks. Pain Physician. 2012;15:E143–50.PubMed
24.
Muro K, O'Shaughnessy B, Ganju A. Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection: case report and review of the literature. J Spinal Cord Med. 2007;30:385–8.PubMed
25.
Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. Am J Roentgenol. 2007;188:1218–21.CrossRef
26.
•• Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine. 2007;32:1249–56. Study based on pain physicians survey about serious neurological complications following CTFESIs.PubMedCrossRef
27.
Baker R, Dreyfuss P, Mercer S, Bogduk N. Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain. 2003;103:211–5.PubMedCrossRef
28.
Lee JY, Nassr A, Ponnappan RK. Epidural hematoma causing paraplegia after a fluoroscopically guided cervical nerve-root injection. A case report. J Bone Joint Surg Am. 2007;89:2037–9.PubMedCrossRef
29.
30.
Stauber B, Ma L, Nazari R. Cardiopulmonary arrest following cervical epidural injection. Pain Physician. 2012;15:147–52.PubMed
31.
Rozin L, Rozin R, Koehler SA, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003;24:351–5.PubMedCrossRef
32.
• Furman MB, Giovanniello MT, O'Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. 2003;28:21–5. Prospective observational clinical study evaluating the incidence of intravascular contrast injection during fluoroscopically-guided CTFESIs.PubMedCrossRef
33.
Malhotra G, Abbasi A, Rhee M. Complications of transforaminal cervical epidural steroid injections. Spine. 2009;34:731–9.PubMedCrossRef
34.
•• Kim do W, Han KR, Kim C, Chae YJ. Intravascular flow patterns in transforaminal epidural injections: a comparative study of the cervical and lumbar vertebral segments. Anesth Analg. 2009;109:233–9. Prospective observational study comparing cervical and lumbar transforaminal epidural steroid injections and showing the incidence much higher than previously reported.PubMedCrossRef
35.
Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 2008;9:227–34.PubMedCrossRef
36.
Huntoon MA. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain. 2005;117:104–11.PubMedCrossRef
37.
Hoang JK, Apostol MA, Kranz PG, et al. CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material. Am J Roentgenol. 2010;195:888–94.CrossRef
38.
Verrills P, Nowesenitz G, Barnard A. Penetration of a cervical radicular artery during a transforaminal epidural injection. Pain Med. 2010;11:229–31.PubMedCrossRef
39.
Kranz PG, Raduazo P, Gray L, Kilani RK, Hoang JK. CT fluoroscopy-guided cervical interlaminar steroid injections: safety, technique, and radiation dose parameters. Am J Neuroradiol. 2012;33:1221–4.PubMedCrossRef
40.
Khan S, Pioro EP. Cervical epidural injection complicated by syrinx formation: a case report. Spine. 2010;35:E614–6.PubMed
41.
Kim H, Lee SH, Kim MH. Multislice CT fluoroscopy-assisted cervical transforaminal injection of steroids: technical note. J Spinal Disord Tech. 2007;20:456–61.PubMedCrossRef
42.
Narouze SN. Ultrasound-guided interventional procedures in pain management: evidence-based medicine. Reg Anesth Pain Med. 2010;35:S55–8.PubMedCrossRef
43.
• McLean JP, Sigler JD, Plastaras CT, Garvan CW, Rittenberg JD. The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography. Pm R. 2009;1:636–42. Retrospective analysis comparing the detection rate of intravascular injections with and without DSA, showing that it improves the detection rate of intravascular injection during CTFESIs.PubMedCrossRef
44.
Karasek M, Bogduk N. Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med. 2004;5:202–5.PubMedCrossRef
45.
Smuck M, Maxwell MD, Kennedy D, Rittenberg JD, Lansberg MG, Plastaras CT. Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections. Spine J. 2010;10:857–64.PubMedCrossRef
46.
Chung SG. Convulsion caused by a lidocaine test in cervical transforaminal epidural steroid injection. Pm R. 2011;3:674–7.PubMedCrossRef
47.
Heavner JE, Racz GB, Jenigiri B, Lehman T, Day MR. Sharp vs blunt needle: a comparative study of penetration of internal structures and bleeding in dogs. Pain Pract. 2003;3:226–31.PubMedCrossRef
48.
Smuck M, Leung D. Inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle. Spine. 2011;36:E220–3.PubMedCrossRef
49.
Candido KD, Ghaly RF, Mackerley S, Knezevic NN. A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections. South Med J. 2010;103:679–82.PubMedCrossRef
50.
Heavner JE, Racz GB. Using procedure-specific needles: what is blunt? South Med J. 2010;103:604.PubMedCrossRef
Metadaten
Titel
Cervical Epidural Steroid Injections for the Treatment of Cervical Spinal (Neck) Pain
verfasst von
Kenneth D. Candido
Nebojsa ‘Nick’ Knezevic
Publikationsdatum
01.02.2013
Verlag
Current Science Inc.
Erschienen in
Current Pain and Headache Reports / Ausgabe 2/2013
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-012-0314-7

Weitere Artikel der Ausgabe 2/2013

Current Pain and Headache Reports 2/2013 Zur Ausgabe

Anesthetic Techniques in Pain Management (KA Williams, Section editor)

Principles of Electrical Stimulation and Dorsal Column Mapping as it Relates to Spinal Cord Stimulation: An Overview

Anesthetic Techniques in Pain Management (KA Williams, Section Editor)

Complementary and Alternative Treatments for Chronic Pelvic Pain

Trigeminal Autonomic Cephalalgias (MS Matharu, Section editor)

The Psychiatric Comorbidities of Cluster Headache

Anesthetic Techniques in Pain Management (KA Williams, Section editor)

Functional Imaging for Interpretation of Pain Pathways: Current Clinical Application/Relevance and Future Initiatives

Anesthetic Techniques in Pain Management (KA Williams, Section editor)

Celiac Plexus Block and Neurolysis for Pancreatic Cancer

Neu im Fachgebiet AINS

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

18.04.2024 | Pädiatrische Notfallmedizin | Nachrichten

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Hochrisiko-Eingriffe für postoperative Übelkeit

11.04.2024 | Rückenschmerzen | Nachrichten

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen
weitere anzeigen

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren