Precise Target Site of Ultrasound-Guided C5 Cervical Root Block

Park, Donghwi

doi:10.1097/phm.0000000000000769

Cited by 4 publications

(6 citation statements)

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“…After the explanation about the anti-inflammatory effect of PDRN, the patient provided written informed consent for its use. After obtaining informed consent from the patient, an ultrasound-guided left C5 nerve root block (NRB) using 5.625 mg/3 mL of PDRN (Rejuvenex PDRN, Pharma Research Products, South Korea) was performed [ 11 ] (Fig. 1 ).…”

Section: Case Reportmentioning

confidence: 99%

Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Park

2017

Medicine

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Rationale:Cervical nerve root injury is one of the complications of traumatic cervical spine fracture. Although one of the most effective treatments to reduce inflammation in nerve root injuries is the use of corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and NSAIDs can inhibit bone healing. So, when nerve injury accompanies bone fractures, corticosteroids and NSAIDs have limitations as therapeutic agents. However, polydeoxyribonucleotide (PDRN) may be useful in the treatment of neuropathy or musculoskeletal pain patients with contraindication of the use of corticosteroids because of its anti-inflammatory effect, as revealed in previous studies. To the best of our knowledge, there has been no report of treatment of traumatic nerve root injury due to an articular process fracture with an ultrasound-guided cervical nerve root block (NRB) using PDRN.Patients concerns:A 54-year-old female patient with motor weakness of the left upper extremity and tingling sensation in the left neck and shoulder.Diagnoses:traumatic C5 nerve root injury due to a fracture of the left articular process in the C4 spine.Intervention:Ultrasound-guided C5 NRB using PDRN.Outcomes:Her motor weakness and sensory symptoms of the left upper extremity were significantly improved after treatment using an ultrasound-guided C5 NRB using PDRN.Lessons:Although it is impossible to draw a conclusion from a single case report, we suggest the ultrasound-guided NRB using PDRN could be a useful treatment for alleviating motor weakness and neuropathic pain caused by traumatic spinal nerve root injury in situations where corticosteroids cannot be used.

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Section: Case Reportmentioning

confidence: 99%

Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Park

2017

Medicine

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“…The fluoroscopy‐guided cervical nerve root block (CNRB) is conventionally used for managing cervical radiculopathy . However, several reports of anterior spinal artery syndrome or brain injury occurring during the fluoroscopy‐guided CNRB have shown the possibility that CNRB may also cause severe complications.…”

Section: Introductionmentioning

confidence: 99%

“…The fluoroscopy-guided cervical nerve root block (CNRB) is conventionally used for managing cervical radiculopathy. 1,2 However, several reports of anterior spinal artery syndrome or brain injury occurring during the fluoroscopy-guided CNRB have shown the possibility that CNRB may also cause severe complications. A survey by Ma et al 3 of 1036 consecutive fluoroscopy-guided CNRBs revealed a complication rate of 1.64%, and most of the serious reported complications were commonly associated with intra-arterial injections, which resulted in infarction of the brain stem and the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

“…4 To avoid the penetration of critical vessels, the needle approach in the posterior aspect of the foramen has been popularly used in fluoroscopy-guided CNRB. 1,2,5,6 However, there is always an underlying risk of severe complications due to unintentional intra-arterial injection despite following strict guidelines to minimize the risk. 7 Recently, the use of ultrasound-guided CNRB has been gradually increasing.…”

Section: Introductionmentioning

confidence: 99%

“…7 Recently, the use of ultrasound-guided CNRB has been gradually increasing. 1,5 However, because this technique cannot make perforating vessels visible and may not be able to differentiate arterial from venous flow, it is currently recommended that ultrasound never be used in isolation, and the findings must be confirmed with fluoroscopy. Also, there has not been a study of the vulnerable vessels at C3-7 during CNRB that can be visualized with ultrasound.…”

Section: Introductionmentioning

confidence: 99%

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Distribution Patterns of Vasculature Around Cervical Nerve Roots

Park

Ryu

2019

PM&R

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Background To the authors' knowledge, there has not been an ultrasound study of the vulnerable vessels in a C3‐7 cervical nerve root block (CNRB). Objectives To evaluate the prevalence of vulnerable vessels around the target of a CNRB at the cervical nerve root of C3‐7 levels in a clinical setting. Design Retrospective, cross‐sectional study. Setting General teaching hospital, rehabilitation unit. Participants A total of 104 patients complaining of neck or arm pain with no prior surgical history and who had undergone a CNRB at an outpatient clinic from May 2015 to December 2017 were included. Main outcome measurements The prevalence of vulnerable vessels as seen on a preprocedure ultrasound scan around the target of a CNRB at the cervical nerve root of C3‐7 levels. Results Out of 104 cases, the C3 level had 7 blood vessels (8.33%), the C4 level had 14 blood vessels (13.86%), the C5 level had 17 blood vessels (16.35%), the C6 level had 27 blood vessels (25.96%), and the C7 level had 31 blood vessels (29.81%) either at the targeted cervical nerve root or at the site of the imaginary needle's projected pathway to the targeted cervical nerve root. Conclusion There was a substantial prevalence of vulnerable vessels either at the targeted nerve root or at the site of the needle's projected pathway to the nerve root.

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Predictability of severity of disc degeneration and disc protrusion using horizontal displacement of cervical dynamic radiographs

et al. 2018

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The aim of this study is to investigate the usefulness of flexion-extension (dynamic) radiographs in evaluating the severity of disc degeneration and disc protrusion in cervical magnetic resonance image (MRI). Patients complaining of neck or arm pain with no prior surgical history and who had undergone both cervical MRI and dynamic radiographs were included in this study. The following patients were excluded: those who had any history of trauma, autoimmune disease such as rheumatoid arthritis or ankylosing spondylitis, prior cervical fracture or prior cervical spine surgery. Based on these criteria, 161 patients who visited our department for neck pain or upper extremity radicular symptoms were initially included retrospectively. Among them, 69 patients were excluded due to the lack of cervical MRI or dynamic radiographs. Therefore, a total of 92 patients were included for analysis in this study. The maximal diameter of disc protrusion in sagittal or axial MRI, the severity of cervical disc degeneration, and segmental horizontal displacement in dynamic cervical radiographs are the main outcome measurements. In the results of this study, the extension radiograph of C5/6 had the highest sensitivity (93.33%) and specificity (100%) in predicting cervical disc protrusion followed by C4/5 (sensitivity; 77.28%, specificity 92.86%) among the dynamic radiographs. Segmental horizontal displacement at the C3/4, C4/5, and C5/6 level in the neutral and extension radiographs had a significant correlation with the severity of cervical disc degeneration in MRI (P < .05). At the C6/7 level, however, only extension radiograph had a significant correlation with the severity of cervical disc degeneration in the MRI (P < .05). In conclusion, if MRI is not available in a primary clinical setting, dynamic cervical radiographs may be useful in predicting the severity of degenerative disc and disc protrusion in cervical MRI. Among the dynamic cervical radiographs, the extension radiograph was the most sensitive for predicting the severity of cervical disc degeneration and disc protrusion, especially at the C3/4, C4/5, C5/6, and C6/7 levels in MRI.

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Precise Target Site of Ultrasound-Guided C5 Cervical Root Block

Cited by 4 publications

References 5 publications

Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Distribution Patterns of Vasculature Around Cervical Nerve Roots

Predictability of severity of disc degeneration and disc protrusion using horizontal displacement of cervical dynamic radiographs

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