BACKGROUND AND PURPOSE:Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB.
BACKROUND AND PURPOSE:Our aim was to evaluate the safety and clinical utility of a fluoroscopically guided anterolateral oblique approach technique for outpatient diagnostic and therapeutic selective cervical nerve root blockade (SCNRB). MATERIALS AND METHODS:During a 13-year period (1994( through February 2007, 4612 patients underwent fluoroscopically guided diagnostic and/or therapeutic extraforaminal SCNRB by using an anterior oblique approach at affiliated outpatient imaging centers. Each procedure was performed by 1 of 6 procedural radiologists, all highly experienced in and actively performing spinal injections on a full-time basis in clinical practice. All of the proceduralists were thoroughly experienced with lumbar injections before endeavoring to perform SCNRBs. Nonionic contrast was injected in nearly all patients (except isolated patients with contrast allergy), and a minimum of 2 projection filming procedures were performed to document the accuracy of needle placement and contrast dispersal before the injection of therapeutic substances. All clinically significant complications beyond skin discoloration and temporary exacerbation of symptoms were recorded. RESULTS:There were no serious neurologic complications, such as stroke, spinal cord insult, or permanent nerve root deficit. One life-threatening anaphylactic reaction occurred and was attributed to the injected materials and not the specific procedure itself. Another patient had a 3-to 4-minute grand mal seizure, from which he fully recovered within 30 minutes. There were no infections. CONCLUSION:The technique we describe for fluoroscopically guided SCNRB is a useful and safe outpatient procedure when performed by skilled and experienced proceduralists.T ransforaminal selective cervical nerve root blockade (SCNRB) is used both as a diagnostic and therapeutic procedure in patients with cervical radiculopathy. There is general agreement and support that image guidance is required for SCNRB to be performed safely and accurately.1-9 CT, 1,2,4,5 CT fluoroscopy, 7 and fluoroscopy 3,6,8,9 are all used and advocated for image guidance during performance of this procedure. Meticulous attention to needle placement with fluoroscopic guidance has proved that neurologic complications can be avoided.9 An interlaminar catheter technique for SCNRB by using fluoroscopy has also been described 10,11 and challenged 12 as an alternative to either the lateral or anterolateral approach. Devastating neurologic complications, including cerebral and spinal cord infarction, have been described with SCNRB, 13-24 resulting in some questioning the safety and appropriateness of this procedure in clinical practice. [25][26][27][28][29] We reviewed our series of 4612 cases of either 1-or 2-level (sequential) SCNRB using an antero-oblique approach performed for 13 years by 6 different procedural radiologists and found no serious irreversible neurologic complications. We describe our technique and discuss why we believe it allows us to perform this procedure safely and accurate...
The potential role of magnetic resonance (MR) imaging in the diagnosis and local staging of testicular tumors was evaluated in 23 patients who subsequently underwent surgery or biopsy. Findings at MR imaging were compared with those at ultrasonography (US) and were correlated with the surgical-histologic findings. At surgery, three patients were found to have extratesticular and 20 patients intratesticular abnormalities. This distinction had been correctly made with both imaging modalities, but US did not demonstrate the intratesticular abnormality in four patients with diffuse infiltrating tumors. Neither modality allowed differentiation of benign from malignant disorders. When local tumor staging was analyzed in 11 patients, the accuracy of both modalities was disappointing (true-positive findings with MR imaging in seven patients and with US in five). At present, US remains the primary imaging modality for testicular disease. MR imaging should be employed when findings at physical examination and US are discrepant and considered when diffuse infiltrative disease is suspected.
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