Infiltrations rachidiennes autres que lombaires

Abstract

Spinal steroid injections are much less frequently performed at the thoracic or cervical levels than at the lumbar spine. Preoperative workup should include a clinical and para-clinical imaging evaluation to detect the inflammatory targets. At the thoracic level, steroid injections of the costo-transverse or costo-vertebral or posterior (or zygapohyseal) joints, unilateral or bilateral can be performed. The anatomo-clinical concordance can best be obtained by anesthetic blocks. For this injection, a particulate corticosteroid (prednisolone acetate) or non-particulate corticosteroid (dexamethasone) may be used. Thoracic epidural injections do not have indications in rheumatology. In our opinion, epidural injections should not be performed at the cervical level, Indications of steroid injections of the zygapohyseal joints at the cervical level should be limited to cases of cervical neuralgia resistant to conservative treatment, selected in a multidisciplinary collaborative meeting, after checking that the injection site is distant from a operated level and that there is no large veins facing the articular mass at MRI at the site of planned injection. The injections of the joint in the area of the cervico-occipital hinge (in particular C1-C2 lateral joint) must be decided in a multidisciplinary meeting and the patient must be informed of the risks of serious neurological accident.