Cervical Transforaminal Injection: Review of the Literature,
Complications, and a Suggested Technique

Windsor, Robert E.; Storm, Seneca; Sugar, Ross; Nagula, Diwakar

doi:10.36076/ppj.2003/6/457

Cited by 78 publications

(7 citation statements)

References 68 publications

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“…4 5 However, safety issues regarding the TF approach have emerged and catastrophic complications such as cerebral or spinal cord infarct and transient ischaemic attack have been reported on numerous occasions. [6][7][8][9][10] These complications cause serious neurologic sequelae to the patient; thus it has become difficult for physicians to decide whether to continue with or withdraw the TF approach. However, direct trauma to the spinal cord or nerves has been reported during the interlaminar approach, although only a few cases of minor complications have been reported following the procedure.…”

mentioning

confidence: 99%

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Choi

Nahm

Lee

2015

British Journal of Anaesthesia

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mentioning

confidence: 99%

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Choi

Nahm

Lee

2015

British Journal of Anaesthesia

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“…19 The greater percentage of cervicothoracic interlaminar than transforaminal epidural injections (55.2% vs 11.3%) is likely due to the greater risks associated with transforaminal cervicothoracic injections attributed to accidental vascular injection. 20,21 Facet injections were the second most cervicothoracic injection type at 33.4% of those performed. Notably, facet injections are more commonly used for axial pain.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Utilization of Cervicothoracic Injections Between 2010 and 2020

Ratnasamy,

Oghenesume,

Maloy

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Descriptive epidemiologic study. Objective: To analyze trends and patient characteristics of those undergoing cervicothoracic transforaminal, interlaminar, and facet injections over time. Background: Cervicothoracic transforaminal, interlaminar, and facet injections are considered for varied spinal pathologies. Evolving literature, changing physician preferences, insurance reimbursement policies, and patient factors may influence the utilization of such injections over time. Methods: Patients undergoing cervicothoracic transforaminal, interlaminar, and facet injections 2010–2020 were identified in the M151Ortho PearlDiver database using Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index, insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, and West) were extracted and assessed over study intervals based on prevalence per 100,000 covered lives. Results: Cervicothoracic transforaminal, interlaminar, and facet injections were identified for 195,221 (11.3%), 951,191 (55.2%), and 575,228 (33.4%) patients, respectively. Patient characteristics for each injection type were defined. The annual number of injections performed per 100,000 covered lives decreased during the study period for transforaminal (17.1% decrease) and interlaminar (9.3% decrease) but increased for facet (3.7% increase) injections (P<0.0001 for each). Stratifying by patient insurance type, administration of transforaminal, interlaminar, and facet injections per 100,000 covered lives was proportionally greatest for commercially insured patients (55%, 50%, and 45%, respectively), and proportionally smallest for Medicaid patients (10%, 13%, and 13%, respectively). Anesthesiology physicians performed the most injections, followed by physical medicine and rehabilitation physicians, with both provider types most frequently performing interlaminar injections, followed by facet and transforaminal injections. Conclusion: Annual cervicothoracic transforaminal and interlaminar injection utilization declined by 17.1% and 9.3% from 2010 to 2020, whereas facet injection administration increased by 3.7% over the same interval. Evolving practice patterns are important to consider in characterizing the overall landscape of spine care.

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“…The pathological location of CSR was classified as intervertebral foramen and posterolateral 10 , 11 . ACDF combined with ACF can directly and effectively remove nerve root compression, reconstruct the stability of diseased segments, and improve the physiological curvature of cervical vertebra.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cervical Discectomy and Fusion Combined with Foraminotomy Assisted by High‐Definition 3‐Dimensional Exoscope in the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis

Bai

Wang

et al. 2021

Orthopaedic Surgery

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Objective: To evaluate the outcomes of cervical spondylotic radiculopathy secondary to bony foraminal stenosis treated with anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) assisted by High-Definition 3-Dimensional Exoscope. Methods:In this retrospective study, a total of 19 consecutive patients (12 males and seven females, with an average of 49.2 years, range from 40 to 59 years) with spondylotic radiculopathy caused by bony foraminal stenosis underwent ACDF combined with ACF assisted by High-Definition 3-Dimensional Exoscope in our hospital between January 2019 and December 2019 were included in this study. All patients signed the consent form before the surgery. The patient baseline information such as gender, age, body mass index (BMI), surgery time, blood loss, hospital stay, lesion segment, side, follow-up time and postoperative complications were recorded. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) were measured and compared before surgery, 1 months and final follow-up after surgery. The radiographic outcomes were evaluated using the C 2 -C 7 angel, disc height, foraminal height, superior diagonal distance, inferior diagonal distance, and foraminal area. Results:The involved levels included C 4 -C 5 (six cases), C 5 -C 6 (10 cases), C 6 -C 7 (three cases). The mean duration of the surgery, mean blood loss, mean hospital stay, and mean follow-up were 100 AE 11.10 min, 19.4 AE 7.05 mL, 7.1 AE 0.99 days, and 12.1 AE 2.25 months, respectively. The average preoperative JOA score was 11.9 AE 1.31, then improved to 15.7 AE 0.73 (t = À13.45, P < 0.001) and 16.2 AE 0.74 (t = À14.39, P < 0.001) at 1 month after operation and at last follow-up, respectively. The average preoperative NDI score was 27.3 AE 3.36, then decreased to 5.1 AE 1.79 (t = 20.63, P < 0.001) and 4.5 AE 1.21 (t = 25.53, P < 0.001) 1 month after operation and at last followup, respectively. The average preoperative VAS score was 6.7 AE 0.93, then decreased to 2.4 AE 0.69 (t = 15.05, P < 0.001) and 1.9 AE 0.78 (t = 16.40, P < 0.001) 1 month after operation and at last follow-up, respectively. As compared with the condition before surgery, there was a significant improvement in the C 2 -C 7 angel, disc height, foraminal height, and foraminal area (P < 0.05). None of the patients developed postoperative vascular injury, nerve injury, loosening and rupture of the internal fixation, displacement of interbody fusion cage, and pseudarthrosis. Conclusion:ACDF combined with ACF assisted by High-Definition 3-Dimensional Exoscope is effective and safe for the treatment of CSR caused by secondary to bony foraminal stenosis.

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Cervical Transforaminal Injection: Review of the Literature, Complications, and a Suggested Technique

Cited by 78 publications

References 68 publications

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection

Changes in the Utilization of Cervicothoracic Injections Between 2010 and 2020

Anterior Cervical Discectomy and Fusion Combined with Foraminotomy Assisted by High‐Definition 3‐Dimensional Exoscope in the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis

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