CT-Guided Cervical Selective Nerve Root Block with a Dorsal Approach

Abstract

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.

Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

“…All injections were categorized by needle tip position relative to the targeted lumbar neural foramen at the time of injection using a three-part categorization similar to a scheme previously described for cervical TFESIs (11,13,14).…”

Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

“…Optimal needle position was at the anterior lateral margin of the facet at the affected neural foramen. 6 The needle was placed just superficial to the periosteum with its opening directed ventrally. Skin anesthetic was used as necessary.…”

“…Lack of real-time vascular contrast imaging is a potential limiting feature. 6,7 The aim of all such procedures, regardless of the technique, is to infiltrate near the exiting nerve root and/or epidural space at the affected level to reduce inflammation believed to cause the patient's discomfort. This is performed while attempting to minimize potential complications, the most feared being inadvertent brain stem or spinal cord embolization.…”

The role of needle tip position on the accuracy of diagnostic selective nerve root blocks in spinal deformity

“…More recently, a number of factors have been introduced to try to improve accuracy including use of a low volume of injectate, CT guidance or electrostimulation [2,4,5,10,11]. CT guidance and electrostimulation such as the Stimuplex Ò D needle (Braun medical) can indeed help to guide needle placement to the required nerve root but do not address the problems with inadvertent spread of injectate onto traversing nerve roots.…”

“…He used fluoroscopic guidance from a postero-lateral approach to position the needle tip into the root sleeve with the use of radio-opaque dye and characteristic pain provocation [1]. Despite the introduction of CT, ultrasound and electrostimulation for guidance [2][3][4][5][6], selective nerve root blocks have changed little in technique and are still widely used today as a diagnostic tool [7].…”