Chronic Cervical Radiculopathy: Lateral-Approach Periradicular Corticosteroid Injection

Vallée, Jean-Noël; Feydy, A.; Carlier, Robert; Mutschler, C.; Mompoint, D.; Vallée, C.

doi:10.1148/radiology.218.3.r01mr17886

Cited by 137 publications

(81 citation statements)

References 16 publications

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“…Because of the anatomy of the cervical spine, cervical transforaminal injections may be technically challenging, and associated with potential morbidity and mortality [5]. Currently, procedures for cervical periradicular injections are preferentially radiographically controlled interventions [2,6]. In the past, ultrasound (US) has been demonstrated to facilitate the localization and imaging of peripheral nerves, spinal nerve roots and also bony parts of the spine such as facet joints.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

et al. 2013

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Purpose We conducted this study to evaluate accuracy, time saving, radiation doses, safety, and pain relief of ultrasound (US)-guided periradicular injections versus computed tomography (CT)-controlled interventions in the cervical spine in a prospective randomized clinical trial. Methods Forty adult patients were consecutively enrolled and randomly assigned to either a US or a CT group. USguided periradicular injections were performed on a standard ultrasound device using a broadband linear array transducer. By basically following the osseous landmarks for level definition in ''in-plane techniques'', a spinal needle was advanced as near as possible to the intended, US-depicted nerve root. The respective needle tip positioning was then verified by CT. The control group underwent CT-guided injections, which were performed under standardized procedures using the CT-positioning laser function. Results The accuracy of US-guided interventions was 100 %. The mean time to final needle placement in the US group was 02:21 ± 01:43 min:s versus 10:33 ± 02:30 min:s in the CT group. The mean dose-length product radiation dose, including CT confirmation for study purposes only, was 25.1 ± 16.8 mGy cm for the US group and 132.5 ± 78.4 mGy cm for the CT group. Both groups showed the same significant visual analog scale decay (p \ 0.05) without ''inter-methodic'' differences of pain relief (p [ 0.05). Conclusions US-guided periradicular injections are accurate, result in a significant reduction of procedure expenditure under the avoidance of radiation and show the same therapeutic effect as CT-guided periradicular injections.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

et al. 2013

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“…The role of selective nerve root blocks (SNRB) in treating cervical radiculopathy has been explored by various investigators [9,10,22,23] as has been summarised in Table 4. Delivery of steroids around the nerve root near the site of its compression is achieved through percutaneous injection technique using fluoroscopy or CT guidance.…”

Section: Discussionmentioning

confidence: 99%

“…Delivery of steroids around the nerve root near the site of its compression is achieved through percutaneous injection technique using fluoroscopy or CT guidance. The Table 2 Improvement in outcome scores (VAS and NDI) at 6 weeks and 1 year after the procedure at different levels techniques previously described in the literature used single needles ranging in size from 21G to 25G [6,7,9,10,23]. Morvan et al described an antero-lateral approach similar to a cervical discographic approach.…”

Section: Discussionmentioning

confidence: 99%

“…Vallee et al reported significant reduction in pain in 62% of 32 patients with cervical radiculopathy treated with SNRBs. They injected the steroid with a 21G spinal needle under fluoroscopy control and did not use the contrast to confirm needle tip position [9]. Larkin et al described a technique in which a catheter is entered into the posterior epidural space via a more caudal route and advanced up the spinal canal and turned into the target foramen essentially performing an ''inside-out'' injection [25].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is generally reserved for unremitting and severe pain in patients in whom nonoperative treatment has failed [4,5]. One effective modality of treatment for patients with unremitting pain is injection of steroid and local anaesthetic in the nerve root foramen into the peri-radicular space -cervical foraminal 'selective nerve root block' (SNRB) [6][7][8][9][10]. Here we describe a method of SNRB using a 'two-needle technique' with a 2-year follow-up of 30 patients in our centre.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cervical foraminal selective nerve root block: a ‘two-needle technique’ with results

Kumar

Gowda

2008

Eur Spine J

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Several techniques have been described for selective nerve root blocks. We describe a novel 'two-needle technique', performed through the postero-lateral route with the patient in lateral position under C-arm guidance.The aim of the current study is to highlight the effectiveness and safety of cervical selective nerve root block for radiculopathy using this technique. We present results of a retrospective 2-year follow-up study of 33 injections carried out on 33 patients with radiculopathy due to cervical disc disease and or foraminal stenosis using this procedure. Patients with myelopathy, gross motor weakness and any other pathology were excluded. The outcome was measured comparing 'Visual Analogue Score' (VAS) and 'Neck Disability Index' (NDI) before the procedure with those at 6 weeks and 12 months after the procedure. Thirty patients were included in the final analysis. Average pre-operative VAS score was 7.4 (range 5-10), which improved to 2.2 (range 0-7) at 6 weeks and 2.0 (range 0-4) at 1 year and the mean NDI score prior to intervention was 66.9 (range 44-84), which improved to 31.7 (range 18-66) at 6 weeks and 31.1 (range 16-48) at 1 year. The improvements were statistically significant. Patients with involvement of C6 or C7 nerve roots responded slightly better at 6 weeks with regards to VAS improvement. Mean duration of radiation exposure during the procedure was 27.8 s (range 10-90 s). Only minor complications were noted-transient dizziness in two and transient nystagmus in one patient. Our 'twoneedle technique' is a new, safe and effective non-surgical treatment for cervical radiculopathy.

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Ultrasound guided therapeutic injections of the cervical spine and brachial plexus

Cormick¹

2014

Australas J Ultrason Med

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Introduction: Recent applications in ultrasound imaging include ultrasound assessment and ultrasound guided therapeutic injections of the spine and brachial plexus. Discussion: Ultrasound is an ideal modality for these regions as it allows accurate safe and quick injection of single or multiple sites. It has the added advantages of lack of ionising radiation, and can be done without requiring large expensive radiology equipment. Conclusion: Brachial plexus pathology may be present in patients presenting for shoulder symptoms where very little is found at imaging the shoulder. It is important to understand the anatomy and normal variants that may exist to be able to recognise when pathology is present. When pathology is demonstrated it is easy to do a trial of therapy with ultrasound guided injection of steroid around the nerve lesion. This review will outline the normal anatomy and variants and common pathology, which can be amenable to ultrasound guided injection of steroid.

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Chronic Cervical Radiculopathy: Lateral-Approach Periradicular Corticosteroid Injection

Cited by 137 publications

References 16 publications

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

Cervical foraminal selective nerve root block: a ‘two-needle technique’ with results

Ultrasound guided therapeutic injections of the cervical spine and brachial plexus

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