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Erschienen in: Skeletal Radiology 12/2011

01.12.2011 | Technical Report

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

verfasst von: Reto Sutter, Christian W. A. Pfirrmann, Marco Zanetti, Juerg Hodler, Cynthia K. Peterson

Erschienen in: Skeletal Radiology | Ausgabe 12/2011

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Abstract

Objective

To describe an “indirect” cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the “direct” cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures.

Materials and methods

The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009–2010 were age- and gender-matched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20–30 min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student’s t test.

Results

Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P = 0.455). No immediate or late adverse effects were reported after either injection procedure.

Conclusions

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.
Literatur
1.
Zurück zum Zitat Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000;81:741–6.CrossRefPubMed Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000;81:741–6.CrossRefPubMed
2.
Zurück zum Zitat Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006;7:237–42.CrossRefPubMed Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006;7:237–42.CrossRefPubMed
3.
Zurück zum Zitat Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections. More dangerous than we think? Spine. 2007;32:1249–56.CrossRefPubMed Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections. More dangerous than we think? Spine. 2007;32:1249–56.CrossRefPubMed
4.
Zurück zum Zitat Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976–1990. Brain. 1994;117:325–35.CrossRefPubMed Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976–1990. Brain. 1994;117:325–35.CrossRefPubMed
5.
Zurück zum Zitat Strobel K, Pfirrmann CWA, Schmid M, Hodler J, Boos N, Zanetti M. Cervical nerve root blocks: indications and role of MR imaging. Radiology. 2004;233:87–92.CrossRefPubMed Strobel K, Pfirrmann CWA, Schmid M, Hodler J, Boos N, Zanetti M. Cervical nerve root blocks: indications and role of MR imaging. Radiology. 2004;233:87–92.CrossRefPubMed
6.
Zurück zum Zitat Vallée JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallée CA. Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology. 2001;218:886–92.CrossRefPubMed Vallée JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallée CA. Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology. 2001;218:886–92.CrossRefPubMed
7.
Zurück zum Zitat Windsor RE, Storm S, Sugar R, Nagula D. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician. 2003;6:457–65.PubMed Windsor RE, Storm S, Sugar R, Nagula D. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician. 2003;6:457–65.PubMed
8.
Zurück zum Zitat Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine. 2008;33(Suppl):S153–69.CrossRefPubMed Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine. 2008;33(Suppl):S153–69.CrossRefPubMed
9.
Zurück zum Zitat Huntoon MA. Cervical spine: case presentation, complications, and their prevention. Pain Med. 2008;9:S35–40.CrossRef Huntoon MA. Cervical spine: case presentation, complications, and their prevention. Pain Med. 2008;9:S35–40.CrossRef
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat Brouwers PJAM, Kottink EJBL, Simon MAM, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. 2001;91:397–9.CrossRefPubMed Brouwers PJAM, Kottink EJBL, Simon MAM, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. 2001;91:397–9.CrossRefPubMed
12.
Zurück zum Zitat Rosenkranz M, Grzyska U, Niesen W, Fuchs K, Schummer W, Weiller C, et al. Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol. 2004;251:229–31.CrossRefPubMed Rosenkranz M, Grzyska U, Niesen W, Fuchs K, Schummer W, Weiller C, et al. Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol. 2004;251:229–31.CrossRefPubMed
13.
Zurück zum Zitat Karasek M, Bogduk N. Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med. 2004;5:202–5.CrossRefPubMed Karasek M, Bogduk N. Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med. 2004;5:202–5.CrossRefPubMed
14.
Zurück zum Zitat Tiso RL, Cutler T, Catania JA, Whalen BS, Pharm BCPS. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004;4:468–74.CrossRefPubMed Tiso RL, Cutler T, Catania JA, Whalen BS, Pharm BCPS. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004;4:468–74.CrossRefPubMed
15.
Zurück zum Zitat Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol. 2007;188:1218–21.CrossRefPubMed Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol. 2007;188:1218–21.CrossRefPubMed
16.
Zurück zum Zitat Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am. 2008;90:1932–8.CrossRefPubMed Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am. 2008;90:1932–8.CrossRefPubMed
17.
Zurück zum Zitat Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol. 2007;36:449–52.CrossRefPubMed Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol. 2007;36:449–52.CrossRefPubMed
18.
Zurück zum Zitat Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, 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.CrossRefPubMed Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, 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.CrossRefPubMed
19.
Zurück zum Zitat Furman MB, Giovanniello MT, O’Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. 2003;28:21–5.CrossRefPubMed Furman MB, Giovanniello MT, O’Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. 2003;28:21–5.CrossRefPubMed
20.
Zurück zum Zitat Rao R. Neck Pain, Cervical radiculopathy and cervical myelopathy. Pathophysiology, natural history and clinical evaluation. J Bone Joint Surg Am. 2002;84-A:1872–81.CrossRef Rao R. Neck Pain, Cervical radiculopathy and cervical myelopathy. Pathophysiology, natural history and clinical evaluation. J Bone Joint Surg Am. 2002;84-A:1872–81.CrossRef
22.
Zurück zum Zitat Pfirrmann CW, Oberholzer PA, Zanetti M, Boos N, Trudell DJ, Resnick D, et al. Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectiveness—a study with patients and cadavers. Radiology. 2001;221:704–11.CrossRefPubMed Pfirrmann CW, Oberholzer PA, Zanetti M, Boos N, Trudell DJ, Resnick D, et al. Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectiveness—a study with patients and cadavers. Radiology. 2001;221:704–11.CrossRefPubMed
23.
Zurück zum Zitat Wolter T, Mohadjer M, Berlis A, Knoeller S. Cervical CT-guided, selective nerve root blocks: improved safety by dorsal approach. Am J Neuroradiol. 2009;30:336–7.CrossRefPubMedPubMedCentral Wolter T, Mohadjer M, Berlis A, Knoeller S. Cervical CT-guided, selective nerve root blocks: improved safety by dorsal approach. Am J Neuroradiol. 2009;30:336–7.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Wolter T, Knoeller S, Berlin A, Hader C. CT-guided cervical selective nerve root block with a dorsal approach. Am J Neuroradiol. 2010;31:1831–6.CrossRefPubMedPubMedCentral Wolter T, Knoeller S, Berlin A, Hader C. CT-guided cervical selective nerve root block with a dorsal approach. Am J Neuroradiol. 2010;31:1831–6.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Hechelhammer L, Pfirrmann CW, Zanetti M, Hodler J, Boos N, Schmid MR. Imaging findings predicting the outcome of cervical facet joint blocks. Eur Radiol. 2007;17:959–64.CrossRefPubMed Hechelhammer L, Pfirrmann CW, Zanetti M, Hodler J, Boos N, Schmid MR. Imaging findings predicting the outcome of cervical facet joint blocks. Eur Radiol. 2007;17:959–64.CrossRefPubMed
26.
Zurück zum Zitat Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.PubMed Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.PubMed
Metadaten
Titel
CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique
verfasst von
Reto Sutter
Christian W. A. Pfirrmann
Marco Zanetti
Juerg Hodler
Cynthia K. Peterson
Publikationsdatum
01.12.2011
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 12/2011
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-011-1288-y

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