Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

Abstract

• Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids. • The presence of nerve root compression was a predictive finding of 'improvement'. • Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection. • There is less pain relief in patients with disc extrusions. • There are less improvement in patients with modic type I changes.

Safety of CT‐guided cervical nerve root corticosteroid injections

“…Cervical nerve root injection is a common procedure for assessment and treatment of cervical radiculopathy due to nerve root compression and has been performed by radiologists and other pain management specialists under imaging guidance for many decades. Studies have demonstrated the efficacy of the procedure in treating the radiculopathy symptomatically and potentially sparing the need for surgery, as well as predicting the response to surgery . Traditionally, the procedure has been performed under X‐ray fluoroscopic guidance, and many still use this technique today.…”

“…demonstrated a lower rate of intravascular injection with an anterolateral approach when the needle tip placed at the lateral margin of the neural exit foramen . Some authors argue that a posterior/posterolateral or indirect approach may decrease the rate of major neurovascular complications, but given the extreme rarity of such events this would be difficult to measure even with a very large sample size. Also, a posterior approach with advancement of the needle to the posterior margin of the cervical neural foramen does not entirely eliminate the risk of inadvertent contact with the vertebral or radicular arteries if the needle is over‐advanced.…”

“…Studies have demonstrated the efficacy of the procedure in treating the radiculopathy symptomatically and potentially sparing the need for surgery, as well as predicting the response to surgery. 2,3,8,10 Traditionally, the procedure has been performed under X-ray fluoroscopic guidance, and many still use this technique today. However, over recent years, CT guidance has gained favour due to the better spatial resolution of vascular structures and simplicity of needle placement.…”

“…Image-guided cervical nerve root injections have been performed for many decades by radiologists for cervical radiculopathy. After some initial uncertainty about efficacy, 1 more recent studies have demonstrated the efficacy of cervical nerve root injections for alleviating cervical radicular pain thought to be caused by nerve root compression, [2][3][4][5][6][7] as well as potentially postponing or sparing the need for open surgical management. 8,9 Furthermore, symptomatic response to cervical nerve root injection has been identified as a predictor of symptomatic response to surgical decompression.…”

A Randomized Comparative Study of Pulsed Radiofrequency Treatment With or Without Selective Nerve Root Block for Chronic Cervical Radicular Pain

“…Cervical nerve root block (CNRB) and pulsed radiofrequency (PRF) treatments have been used to manage chronic cervical radicular pain . CNRB seems to be more effective in patients with nerve root compression than in those with disk extrusion . Patients with nerve root compression were more likely to report improvement at 1 year.…”