Complications of Cervical Selective Nerve Root Blocks Performed with Fluoroscopic Guidance

Abstract

2Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA. ervical nerve root blocks have been performed since the late 19th century [1], and the use of the procedure has been increasing over the past decade [2]. Cervical nerve root blocks are used to manage or treat spinal pain, radiculopathy, and complex regional pain syndromes. Many such blocks are performed in outpatient clinics with and without imaging guidance such as fluoroscopy or CT. If imaging guidance is not used, palpable anatomic landmarks are generally used to direct needle placement. Various complications associated with the nerve block procedure have previously been described [3–7]. The most serious reported complications include death, stroke, arrhythmias, sensory or motor loss, meningitis, bleeding, and seizures. To our knowledge, arterial dissection has not previously been reported after a cervical selective nerve root block (SNRB). Our purpose is to present two cases that show potentially devastating outcomes when a cervical SNRB is performed using fluoroscopic guidance and to evaluate possible alternative methods currently available.