A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Abstract

The aim is to provide a detailed procedure of a simple and 10-minute cervical nerve root block (CNRB) under ultrasonic guidance, and to report the clinical outcomes, disorders, and complications. Records of patients who had undergone CNRB, were reviewed under ultrasonic guidance at the hospital from 2010 through 2012. The procedure is described in detail. Arm and shoulder pain was evaluated by use of the visual analogue scale (VAS). Forty-three patients agreed to undergo CNRB under ultrasonic guidance. Nerve roots from C5 to C8 were affected in 41, and these nerve roots were readily distinguished. Two of the 43 participants did not receive injections because impediments in visualizing the affected nerve root. Of the 41 who received injections, radicular pain immediately disappeared in 39, who continued to feel pain relief 1 month later. However, pain recurred in 15 patients (38%), of whom 11 underwent cervical spine surgery. The rest of 24 patients felt sustained pain relief longer than 3 months after the injection, significantly. Although one patient had recurrent radicular pain 10 months later, the pain could be controlled by medication. At the final follow-up periods, 17.2 (10–24 months), the median VAS score of the patients, 23 (0 to 71 mm), was significantly improvement (P = 0.001) in comparison to before injection 88 (range; 56–100). No complications occurred. The cervical nerve root block under ultrasonic guidance simply, safely, and efficaciously decreased radicular pain for 17.2 months in 62% patients with intolerable radicular pain.

Combined fluoroscopic and ultrasound guided cervical nerve root injections

“…Ultrasound guidance can help identify anatomical variations and thus avoid injury to aberrant vessels [19,20]. Our study supports the safety profile of this technique with no significant complications experienced by any of our patients.…”

“…Although we do not yet have the long-term follow-up data to clarify how long the effect can last, 26 % of patients had ongoing relief at least six weeks after the procedure. Recent work by Takeuchi et al has shown an average 17-month duration of symptom reduction [20]. In this manner patients, and even some with long-term symptoms, may experience quite significant relief of pain and symptoms with a short and safe procedure that has the potential in some cases to avoid the need for surgical intervention.…”

“…Comparison between the ultrasound and fluoroscopic techniques for selective nerve root block showed no difference in efficacy [19]. Takeuchi et al recently reported a series of 43 patients with a 62 % rate of pain relief for an average of 17 months following injection under ultrasound guidance [20]. To date there are no complications of ultrasound guided selective nerve root block reported in the literature.…”

The Comparation of Ultrasound and Fluoroscopy-guided for Determining Puncture Entry Point of Percutaneous Vertebroplasty

“…US could real-time monitor the puncture procedure without ionizing radiation, since it could distinguish bones, nerves, blood vessels and muscles clearly. Ultrasound scanning technology has been gradually applied in orthopedics, such as lumbar facet joint injection and nerve root block [6,7] . Up to date, the safety and e cacy of ultrasound guidance for determining the entry point of PVP puncture has still no report.…”

Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina

“…1), transforaminal injection or nerve root block [3][4][5], and transforaminal endoscopy [6][7][8][9]. Although usually care is taken with nerves, the blood vessels and ligaments in the LIF have often been ignored by surgeons, and the dangers or complications of these procedures have also been neglected.…”