Cervical Transforaminal Epidural Steroid Injections

Scanlon, G.; Moeller-Bertram, Tobias; Romanowsky, Shawn M.; Wallace, Mark

doi:10.1097/brs.0b013e318053ec50

Cited by 267 publications

(185 citation statements)

References 44 publications

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“…Some authors advocate injecting anesthetic first, followed by steroid after a short delay to assess neurologic deficit. 29,30,37,38 Our data with SCNRB and Ͼ15,000 transforaminal lumbar nerve injections support the safety of admixing local anesthetic and particulate steroid. This technique decreases the total procedure time, reducing the risk of inadvertent needle movement.…”

Section: Discussionmentioning

confidence: 66%

“…1,17,23,24 Although uncommon, complications of SCNRB or transforaminal cervical epidural injections can be devastating. [25][26][27][28][29][30][31][32][33][34][35] Reported major complications include spinal cord and/or brain infarction and death. Direct vascular penetration with intra-arterial injection of anesthetic and particulate steroid, vascular injury with dissection and thrombosis, or direct nerve root or spinal cord injury from the needle or injectant are postulated mechanisms of injury.…”

Section: Discussionmentioning

confidence: 99%

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Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

Pobiel¹,

Schellhas²,

Eklund³

et al. 2009

AJNR Am J Neuroradiol

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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.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

Pobiel¹,

Schellhas²,

Eklund³

et al. 2009

AJNR Am J Neuroradiol

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“…4 Eight major complications have been published, but in all more than 30 cases are known. 5 However, many of them have not been published because they are still sub judice. Among the published cases, there is also 1 case in which CSNRB was performed under CT guidance.…”

Section: Discussionmentioning

confidence: 99%

“…7 In 2007, complications were analyzed after an anonymous survey, and proposals were made to reduce the probability of their occurrence: the use of real-time fluoroscopy to detect vascular uptake, nonparticulate corticosteroids such as dexamethasone, and microbore extension tubing ("pigtail") to minimize needle manipulation while changing syringes. 5 CT guidance for dorsal access offers the possibility of still performing a selective block, as the contrast distribution pattern demonstrates. For the therapeutic efficiency of corticoids, it may not be important if the target point is located slightly more distal because of diffusional spread and strong axonal transport of corticoids.…”

Section: Discussionmentioning

confidence: 99%

Cervical CT-Guided, Selective Nerve Root Blocks: Improved Safety by Dorsal Approach: Fig 1.

Wolter¹,

Mohadjer²,

Berlis³

et al. 2008

AJNR Am J Neuroradiol

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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.

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“…With respect to possible complications, the use of crystalloid and non-crystalloid corticosteroids has been controversial even though there is apparently no major difference in medical effectiveness [45]. It was assumed that complications are based on an embolic mechanism in the case of accidental injection, e. g. into a radicular artery, and corticosteroids with a clumping tendency could have a less favorable risk profile in this context [46]. Tiso et al [47] therefore recommended using non-crystalloid corticosteroids for pain therapy in the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40?mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12???36?min.) for MRI-guided infiltration and 19.7?min. (range: 5???54?min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. Citation Format: ??Maurer MH, Froeling V, R?ttgen R et?al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr R?ntgenstr 2014; 186: 559???566

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Cervical Transforaminal Epidural Steroid Injections

Cited by 267 publications

References 44 publications

Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

Cervical CT-Guided, Selective Nerve Root Blocks: Improved Safety by Dorsal Approach: Fig 1.

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

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