Paravertebral Collateral Arteries in Patients with Carotid Stenosis: Is There a Safe Space for Transforaminal Cervical Nerve Root Injections?

  • Amr MoussaEmail author
  • Adeel Ejaz Syed
  • Aser Farghal
  • Andoni P. Toms
CLINICAL INVESTIGATION Non-Vascular Interventions
Part of the following topical collections:
  1. Non-Vascular Interventions



Image-guided cervical nerve root injections can cause serious complications including spinal cord infarction. This risk may be increased in patients with carotid stenosis who develop collateral arteries. The aim of this study is to describe the prevalence, and anatomical location, of arterial collateral vessels in relation to the optimal needle tip position in cervical nerve root injections.

Materials and Methods

This retrospective study included 25 patients who had > 70% stenosis on a carotid CT angiogram. For each foramen the position of collateral arteries and the most anterior point of the facet joint were recorded, as Cartesian coordinates, by two independent observers. Descriptive statistics were used to analyse and present the results.


14 patients had unilateral and 11 had bilateral stenoses. A total of 85 collaterals were identified at all levels, the most common being C2/3. The median distance from collateral to optimal needle tip placement was 9.6 mm (95% CI median: 6.7–12.4, IQR: 5.6–15.6). The minimum distance was 2.9 mm. Inter-observer reliability was “substantial” (ICC 0.78, 95% CI 0.71–0.83).


Collateral arteries were common in our cohort of patients with carotid artery stenosis and half lay within 10 mm of the optimal position for transforaminal cervical nerve root injection.


Cervical nerve root injections Carotid stenosis Cervical collaterals Optimal needle tip position 


Author’s Contribution

APT: Guarantor of integrity of the entire study. APT, AF: Study concepts and design. AM: Literature search. Clinical studies—N/A. AM, AES: Experimental studies/data analysis. APT: Statistical analysis. AM, AES, APT: Manuscript preparation APT: Manuscript editing.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of RadiologyNorfolk & Norwich University HospitalNorwichUK
  2. 2.Department of RadiologyTawam HospitalAl AinUnited Arab Emirates
  3. 3.Radiology AcademyCotman CentreNorwichUK

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