CT-guided cervical transforaminal epidural steroid injections: Technical insights

Wald, John T.; Maus, Timothy P.; Diehn, Felix E.; Kaufmann, Timothy J.; Morris, Jonathan M.; Murthy, Naveen S.; Thielen, Kent R.

doi:10.1016/j.neurad.2013.08.004

Cited by 11 publications

(12 citation statements)

References 15 publications

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“…Particulate steroids should not be used in cervical TFESI. Computed tomography (CT) guidance offers several advantages over fluoroscopic guidance [ 15 ]. CT guidance can avoid cannulation of small arteries such as vertebral artery and also radical-medullar and other muscular cervical arteries that can sometimes give anatomic branches to radical-medullar arteries.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

2017

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Introduction: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

2017

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“…In the cervical region, neurologic catastrophes have occurred prior to injection of corticosteroid, due to transgression of the vertebral artery and arterial dissection [4]. Theoretically, CT/F guidance could allow access to the cervical neural foramen without the possibility of vertebral artery transgression, as the vessel can be visualized during the course of needle advancement, which is not true for CF [6]. Operator error always may intervene.…”

Section: Discussionmentioning

confidence: 99%

“…The raw data were obtained as dose rates, which were linear over time; doses for lesser exposure times could be easily extrapolated. For the CT/F measurements, two acquisitions were the unit of measurement, as acquisitions during and immediately after cessation of contrast injection have been described as a means of exclusion of vascular filling [6]. Incremental dose for DSA or CT/F was defined as the additional dose for that modality above that incurred by CF (either medium or high-dose rate).…”

Section: Methodsmentioning

confidence: 99%

Radiation Dose Incurred in the Exclusion of Vascular Filling in Transforaminal Epidural Steroid Injections: Fluoroscopy, Digital Subtraction Angiography, and CT/Fluoroscopy

et al. 2014

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The use of DSA imaging to exclude vascular uptake during TFESI increases radiation dose over CF. CT/F incurs additional dose beyond most DSA. Minimizing radiation dose by limiting DSA and CT/F use to spine segments or clinical situations involving higher risk may be desirable. However, the incremental radiation doses incurred by DSA or CT/F are of such low magnitude that health risks cannot currently be estimated.

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“…Important caveats to this approach are the use of CT and nonparticulate steroids in the cervical spine. 16,17 The causes for axial back pain are many, and can be grouped as potential targets for image-guided intervention. Facet syndrome, or symptoms attributable to hypertrophied, osteoarthritic facet articulations, most often includes band-like lower back pain and the absence of sitting pain in a patient with corresponding imaging findings.…”

Section: Spine Pain That Is Unrelated To Cancermentioning

confidence: 99%

Global Approach to the Patient with Pain in Interventional Radiology

Bittman

Friedberg

Fleishon

et al. 2018

Semin intervent Radiol

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CT-guided cervical transforaminal epidural steroid injections: Technical insights

Cited by 11 publications

References 15 publications

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

Radiation Dose Incurred in the Exclusion of Vascular Filling in Transforaminal Epidural Steroid Injections: Fluoroscopy, Digital Subtraction Angiography, and CT/Fluoroscopy

Global Approach to the Patient with Pain in Interventional Radiology

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