BACKGROUND AND PURPOSE:Cervical transforaminal blocks are frequently performed to treat cervical radicular pain. These blocks are performed mostly under fluoroscopy, but a CT-guided technique has also been described. The aim of this study was to review the results of CT-guided CSNRB by using a dorsal approach, to describe the contrast patterns achieved with this injection technique, and to estimate the degree of specificity and sensitivity.

SUMMARY:Cervical transforaminal blocks are frequently performed as a treatment of cervical radicular pain. These blocks are performed mostly under fluoroscopy, but a CT-guided technique also has been described. We describe a modification that leads to a more extraforaminal than transforaminal and equally selective nerve root block. C ervical selective nerve root blocks (CSNRB) are commonly performed with fluoroscopic guidance.1 However, CTguidance is also possible and has been described. CT guidance offers the advantage of enhanced anatomic resolution and a more precise positioning of the needle tip.2 Disadvantages are extended procedure times and increased exposure to radiation. In both the fluoroscopic and the CT-guided CSNRB, the aim is to block the root within the foramen. Therefore, the patient is placed in the supine position, and the foramen is reached laterally in a nearly horizontal plane. We describe a modification of the CT guidance technique in which the patient is in the prone position and the foramen is reached dorsally, with the tip of the needle aiming at the outer confines of the foramen. This technique leads to an extraforaminal, but still selective, nerve root block. It may imply a smaller risk for devastating complications such as spinal cord infarction or cerebellar infarction.

Cryoneurolysis for LFJS can lead to favourable results with sustained pain relief, amelioration of pain-related disability and reduction of depression scores.

We report a case of type 1 complex regional pain syndrome (CRPS I) of the left leg following the implantation of an artificial disc type in the L4/5 segment of the lumbar spine using a midline left-sided retroperitoneal approach. This approach included the mobilisation of the sympathetic trunk with incision and resection of the intervertebral disc. The perioperative and immediate postoperative periods were uneventful, but on the second postoperative day the patient complained of a progressive allodynia of the whole left leg in combination with weakness of the limb. Neurological examination did not reveal any radicular deficit or paresis. A sympathetic reaction following the mobilisation of the sympathetic trunk during the ventral preparation of the spine was suspected and investigated further. A diagnosis of CRPS I was proposed, and the patient was treated with analgesia, co-analgesics for pain alienation, and systemic corticosteroid therapy. A computed tomography-guided sympathetic block and lymphatic drainage were performed. Following conservative orthopaedic rehabilitation therapy, the degree of pain, allodynia, weakness, and swelling were reduced and the condition of the patient was ameliorated. The cost-benefit ratio of spinal arthroplasty is still controversial. The utility of this paper is to debate a possible cause of a painful complication, which can invalidate the results of a successful operation.

The surgical treatment of spinal disorders did not develop before the 1970s of the last century. Previously limited technical possibilities and the danger of infections spinal surgery could not spread wider. This article reviews the history of spinal surgery from first trials as mentioned in the papyrus Smith in 1550 B.C. in Egypt to advanced techniques of today.