Advertisement

Cervical Transforaminal Epidural Injections

  • Anish Sethi
  • Dajie WangEmail author
Chapter

Abstract

Cervical radiculopathy is a common condition, affecting approximately 83 per 100,000 individuals per year. Symptoms are usually described as neck pain with radicular shoulder and arm pain. Cervical transforaminal epidural steroid injections (TFESI) may be performed after failed conservative therapies. Cervical TFESI allows for medication to be administered directly to the affected nerve root. Multiple studies exist showing symptomatic pain relief from cervical TFESI. Severe adverse complications have been reported from this procedure; however, these are preventable by several techniques.

Keywords

Cervical epidural Cervical transforaminal epidural steroid Transforaminal Epidural Steroid Corticosteroid Cervicalgia Neck pain Cervical spine Epidural steroid Cervical radiculopathy Cervical radiculitis 

Recommended Reading

  1. 1.
    Anderberg L, Annertz M, Persson L, Brandt L, Säveland H. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J. 2007;16(3):321–8.CrossRefGoogle Scholar
  2. 2.
    Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injec-tions. JAMA. 2015;313:1713–4.CrossRefGoogle Scholar
  3. 3.
    Costandi SJ, Azer G, Eshraghi Y, et al. Cervical transforaminal epidural steroid injections: diagnostic and therapeutic value. Reg Anesth Pain Med. 2015;40(6):674–80.CrossRefGoogle Scholar
  4. 4.
    Desai A, Saha S, Sharma N, Huckerby L, Houghton R. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability. Skelet Radiol. 2014;43(7):973–8.CrossRefGoogle Scholar
  5. 5.
    Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006;7(3):237–42.CrossRefGoogle Scholar
  6. 6.
    Hoeft MA, Rathmell JP, Monsey RD, Fonda BJ. Cervical transforaminal injection and the radicular artery: variation in anatomical location within the cervical intervertebral foramina. Reg Anesth Pain Med. 2006;31(3):270–4.PubMedGoogle Scholar
  7. 7.
    Huntoon MA. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain. 2005;117:104–11.CrossRefGoogle Scholar
  8. 8.
    Huston CW. Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review. Curr Rev Musculoskelet Med. 2009;2(1):30–42.CrossRefGoogle Scholar
  9. 9.
    Kolstad F, Leivseth G, Nygaard OP. Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study. Acta Neurochir. 2005;147(10):1065–70.CrossRefGoogle Scholar
  10. 10.
    Lin EL, Lieu V, Halevi L, Shamie AN, Wang JC. Cervical epidural steroid injections for symptomatic disc herniations. J Spinal Disord Tech. 2006;19(3):183–6.CrossRefGoogle Scholar
  11. 11.
    Ma DJ, Gilula LA, Riew KD. Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections. J Bone Joint Surg Am. 2005;87(5):1025–30.CrossRefGoogle Scholar
  12. 12.
    Mclean JP, Sigler JD, Plastaras CT, Garvan CW, Rittenberg JD. The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography. PM R. 2009;1(7):636–42.CrossRefGoogle Scholar
  13. 13.
    Okubadejo GO, Talcott MR, Schmidt RE, et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am. 2008;90(9):1932–8.CrossRefGoogle Scholar
  14. 14.
    Radhakrishnan K, Litchy WJ, O’Fallon WM, et al. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325–35.CrossRefGoogle Scholar
  15. 15.
    Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology. 2004;100(6):1595–600.CrossRefGoogle Scholar
  16. 16.
    Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122:974–84.CrossRefGoogle Scholar
  17. 17.
    Rowlingson JC, Kirschenbaum LP. Epidural analgesic techniques in the management of cervical pain. Anesth Analg. 1986;65(9):938–42.CrossRefGoogle Scholar
  18. 18.
    Rozin L, Rozin R, Koehler SA, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003;24(4):351–5.CrossRefGoogle Scholar
  19. 19.
    Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000;81(6):741–6.CrossRefGoogle Scholar
  20. 20.
    Smuck M, Yu AJ, Tang CT, Zemper E. Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles. Spine J. 2010;10(5):367–71.CrossRefGoogle Scholar
  21. 21.
    Smuck M, Maxwell MD, Kennedy D, Rittenberg JD, Lansberg MG, Plastaras CT. Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections. Spine J. 2010;10(10):857–64.CrossRefGoogle Scholar
  22. 22.
    Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine. 2002;27(5):509–14.CrossRefGoogle Scholar
  23. 23.
    Thierry-mieg J. Cervical epidural injections of corticoids in hyperalgiccervico-brachial neuralgias. 1st cervical epidurographical pictures. Rev Rhum Mal Osteoartic. 1961;28:451–3.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Chronic Pain Medicine, Department of AnesthesiologyThomas Jefferson University HospitalPhiladelphiaUSA

Personalised recommendations