European Spine Journal

, 15:1465

Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography

Original Article

Abstract

Transforaminal injections are sometimes used for the diagnosis and treatment of painful conditions in the lumbar and to a lesser degree in the cervical spine. The technique is most often used when investigating/treating radiculopathy caused by degenerative disease. But how selective are the nerve root blocks? What possible structures other than the intended nerve root are affected from such injections? This study was undertaken in order to try to answer these questions, as no study focusing on the possible spread from the transforaminal selective nerve root blocks in the cervical spine has been performed earlier. In three groups of patients, each group including three patients, we injected three different volumes (0.6, 1.1 and 1.7 ml) with a transforaminal technique in the cervical spine. In all the injections, a small amount of contrast media was added. The spread of the injections were then investigated using multi-slice computed tomography with reconstructions. The imaging revealed a possible effect on other nerve roots than the intended ones when a larger volume was used for the root blocks. The spread was related to the injected volume as well as to local anatomy (size of foraminal area). In this study, only 0.6-ml injections could be accepted for being selective enough for diagnostic investigations.

Keywords

Nerve root block Cervical spine Transforaminal Contrast injection Distribution 

References

  1. 1.
    van Akkerveeken PF (1993) The diagnostic value of nerve root sheath infiltration. Acta Ortho Scand 64(Suppl. 251):61–63CrossRefGoogle Scholar
  2. 2.
    Anderberg L, Annertz M, Brandt L, Säveland H (2004) Selective diagnostic cervical nerve root blocks: correlation with clinical symptoms and MRI-pathology. Acta Neurochir 146(6):559–565CrossRefGoogle Scholar
  3. 3.
    Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H (2005) Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J [Epub ahead of print]Google Scholar
  4. 4.
    Baker R, Dreyfuss P, Mercer S, Bogduk N (2003) Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103(1–2):211–215PubMedCrossRefGoogle Scholar
  5. 5.
    Bansal S, Turtle MJ (2003) Inadvertent subdural spread complicating epidural steroid injection with local anaesthetic agent. Anaesth Intensive Care 31(5):570–572PubMedGoogle Scholar
  6. 6.
    Brouwers PJ, Kottink EJ, Simon MA, Prevo RL (2001) A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91(3):397–399PubMedCrossRefGoogle Scholar
  7. 7.
    Cyteval C, Thomas E, Decoux E, Sarrabere MP, Cottin A, Blotman F, Taourel P (2004) Cervical radiculopathy: open study on percutaneus periradicular steroidinfiltration performed under CT control in 30 patients. Am J Neuroradiol 25(3):441–445PubMedGoogle Scholar
  8. 8.
    Furman MB, Giovanniello MT, O’Brien EM (2003) Incidence of intravascular penetration in transforaminal cervical epidural injections. Spine 28(1):21–25PubMedCrossRefGoogle Scholar
  9. 9.
    Jönsson B, Strömqvist B, Annertz M, Holtås S, Sundén G (1988) Diagnostic lumbar nerve root block. J Spinal Disorders 3:232–235Google Scholar
  10. 10.
    Karasek M, Bogduk N (2004) Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med 5(2):202–205CrossRefPubMedGoogle Scholar
  11. 11.
    Kikuchi S (1982) Anatomical and experimental studies of nerve root infiltration. Nippon Seikeigeka Gakkai Zasshi Jul 56(7):605–614Google Scholar
  12. 12.
    Kikuchi S, Macnab I, Moreau P (1981) Localization of the level of symptomatic cervical disc degeneration. J Bone Joint Surg Br 2:272–277Google Scholar
  13. 13.
    Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, Dominick J, Wecht CH (2003) Death during transforaminal steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathology 24:351–355CrossRefGoogle Scholar
  14. 14.
    Slipman CW, Plastaras CT, Palmitier RA, Huston CW, Sterenfeld EB (1998) Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps? Spine 23(20):2235–2242PubMedCrossRefGoogle Scholar
  15. 15.
    Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ (2000) Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain. Arch Phys Med Rehabil 81:741–746PubMedGoogle Scholar
  16. 16.
    Strobel K, Pfirrmann CW, Schmid M, Hodler J, Boos N, Zanetti M (2004) Cervical nerve root blocks, indication and role of MR imaging. Radiology 233(1):87–92PubMedGoogle Scholar
  17. 17.
    Tanaka N, Fujimoto Y, An H, Ikuta Y, Yasuda M (2000) The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine 25(3):286–291PubMedCrossRefGoogle Scholar
  18. 18.
    Tiso RL, Cutler T, Catania JA, Whalen K (2004) Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine 4(4):468–474CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Leif Anderberg
    • 1
  • Hans Säveland
    • 1
  • Mårten Annertz
    • 2
  1. 1.Department of NeurosurgeryUniversity HospitalLundSweden
  2. 2.Section of NeuroradiologyDepartment of Diagnostic Radiology, University Hospital LundSweden

Personalised recommendations