Cervical Transforaminal Injections Research Articles

Cervical brachalgia: Assessment by cervical CT epidurography post transforaminal injection

Adjunct cervical CT epidurography (CCTE) can be used to image impingement in patients with cervical brachalgia undergoing fluoroscopic-guided cervical transforaminal injection (TFI) of steroid/local anaesthetic where magnetic resonance imaging (MRI) is contraindicated. CCTE images of the 9 patients on whom the authors performed CCTE post TFI over 6 years from 1998 to 2003 were retrospectively reviewed. CCTE is able to provide good images of the cervical spinal canal and its contents. CCTE may be an alternative imaging method for impingement in patients with cervical brachalgia contraindicated for MRI.

Complications of Spinal Diagnostic and Treatment Procedures

Background. Spinal intervention procedures are widely practiced. Complications are sometimes described in case reports, but the full spectrum of possible complications has not been comprehensively publicized. The fact that certain complications continue to occur suggests that practitioners may not be fully aware of the nature of possible complications and how to recognize warning signs. Objectives. To highlight the nature of potential complications of spine interventions and to assist practitioners in recognizing warning signs of impending complications so that they might be prevented. Methods. Complications described in the literature and encountered by the authors in medicolegal proceedings were identified. Illustrations of such complications were collated together with illustrations of phenomena that might have led to complications had they not been recognized and the procedure appropriately corrected or abandoned. Results. Infection is a risk common to all invasive procedures. Spinal cord injuries have occurred during cervical medial branch blocks, intra-articular injections, and radiofrequency neurotomy because operators did not obtain correct views of the target region and misdirected their needles or electrodes. Similar errors have occurred in the conduct of lumbar blocks and neurotomy. The complications of lumbar intradiscal procedures include infection, injury to a ventral ramus, and breakage of electrodes. Cervical discography, additionally, can be complicated by spinal cord injury. Cervical transforaminal injections have been complicated by injections into a reinforcing radicular artery or the vertebral artery. Lumbar transforaminal injections have been complicated by intra-arterial injections and subdural or intrathecal injections. Epidural injections can be complicated by subdural or intrathecal injections, or venous puncture resulting in a haematoma. Intra-articular injections of the lateral atlantoaxial joint and sacroiliac joint theoretically could be complicated by injury to adjacent vessels, nerves, or viscera. Discussion. Strict adherence to published guidelines provides safeguards against encountering complications. Complications are avoided by operators knowing all the relevant anatomy of the procedure and being able to recognize aberrations in the procedure as soon as they occur.

Neurological symptoms after cervical transforaminal injection with steroids in a patient with hypoplasia of the vertebral artery

Acta Anaesthesiologica ScandinavicaVolume 52, Issue 1 p. 165-166 Neurological symptoms after cervical transforaminal injection with steroids in a patient with hypoplasia of the vertebral artery W. Ruppen, W. RuppenSearch for more papers by this authorR. Hügli, R. HügliSearch for more papers by this authorS. Reuss, S. ReussSearch for more papers by this authorA. Aeschbach, A. AeschbachSearch for more papers by this authorA. Urwyler, A. UrwylerSearch for more papers by this author W. Ruppen, W. RuppenSearch for more papers by this authorR. Hügli, R. HügliSearch for more papers by this authorS. Reuss, S. ReussSearch for more papers by this authorA. Aeschbach, A. AeschbachSearch for more papers by this authorA. Urwyler, A. UrwylerSearch for more papers by this author First published: 18 December 2007 https://doi.org/10.1111/j.1399-6576.2007.01484.xCitations: 17 Address:Wilhelm RuppenDepartment of AnaesthesiaUniversity Hospital of BaselCH-4031 BaselSwitzerlande-mail: wruppen@gmail.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume52, Issue1January 2008Pages 165-166 RelatedInformation

Comparative Effectiveness of Cervical Transforaminal Injections with Particulate and Nonparticulate Corticosteroid Preparations for Cervical Radicular Pain

Cervical transforaminal epidural injections of corticosteroids have been used in the treatment of radicular pain. Particulate agents have been associated with rare adverse neurological outcomes. It is unknown whether nonparticulate preparations are any less effective than particulate preparations. Therefore, a study was designed to determine whether there is a basis for promoting a theoretically safer nonparticulate corticosteroid preparation. Volunteer patients were randomized to receive a single cervical transforaminal epidural injection with one of two corticosteroid preparations. This study was undertaken in a private practice setting. Those with single-level, unilateral radicular pain with advanced imaging demonstrating single-level neural compression. Patients received a single cervical transforaminal epidural injection with either dexamethasone or triamcinolone. Ratings were obtained by an independent unbiased assessor at 4 weeks via a telephone interview. A visual analog pain scale was used preprocedurally and a verbal integer scale was used at 4 weeks to assess the severity of the patient's radicular pain. As a secondary outcome measure, a patient-specified functional outcome measure was obtained. Both groups exhibited statistically and clinically significant improvements in pain at 4 weeks. Although the triamcinolone group exhibited a somewhat greater improvement, the difference between groups was not significantly different. The study found that the effectiveness of dexamethasone was slightly less than that of triamcinolone, but the difference was neither statistically nor clinically significant. A theoretically safer nonparticulant agent appears to be a valid alternative to particulate agents that have been used to date, and which have been associated with hazard.

Cervical Transforaminal Injection and the Radicular Artery

Cervical Transforaminal Injection and the Radicular Artery

Cervical Transforaminal Injection and the Radicular Artery: Variation in Anatomical Location Within the Cervical Intervertebral Foramina

Recent articles have detailed the adverse events associated with transforaminal steroid injections into the radicular arteries. Guidelines on strict transforaminal epidural techniques have been described to limit complications. There remains limited information regarding the cervical level of entry, location within the intervertebral foramina, and prevalence of the radicular arteries within the population. With the aid of premortem angiography and postmortem latex-injected vasculature, a single detailed cadaveric dissection was performed to elucidate the specific anatomic location of the radicular arteries within the intervertebral foramina and the anastomoses of the arteries to the anterior spinal artery. Five radicular arteries (C5, C6, two at C7, C8) were traced entering the foramina either anteriorly or posteriorly to supply the anterior and posterior spinal arteries. Radicular arteries received blood supply from either the deep cervical (C8) or vertebral arteries. The C8 radicular artery entered the lateral aspect of the foramen and penetrated the dural sleeve within the inferior portion of the foramen, directly inferior to the exiting spinal nerve, to supply the anterior spinal artery. This artery was of a large enough caliber to be entered by a 22-gauge needle. A larger population is necessary to characterize the range of anatomic variations in arterial supply within the foramina. Available studies support the current technique of fluoroscopic needle insertion. Yet, there is wide anatomic variation in the origin and location of these vessels, and even with strict adherence to technique, it is feasible that a properly placed needle could penetrate a radicular artery.

The Practice of Cervical Transforaminal Injection of Steroids Deserves More Scrutiny

The Practice of Cervical Transforaminal Injection of Steroids Deserves More Scrutiny

Cervical transforaminal injection of steroids.

Cervical transforaminal injection of steroids.

Cervical Transforaminal Injection: Review of the Literature, Complications, and a Suggested Technique

The objective of this paper is to review the literature of cervical transforaminal injections, resulting complications, and to suggest a safe technique. A systematic review of the literature was performed. Both the MEDLINE and EMBASE databases were searched for any article relating to cervical epidural injections, cervical transforaminal injections, and complications relating to cervical epidural or cervical transforaminal injections. Finally, a method for performing a cervical transforaminal injection safely is described. The review of the literature revealed: 1. There is a paucity of literature regarding cervical transforaminal injections; 2. There is no accepted standard technique for performing cervical transforaminal injections; and 3. More research and study must be performed regarding the risk versus benefit, technique, and outcome of cervical transforaminal injections.

Cortical Blindness and Neurologic Injury Complicating Cervical Transforaminal Injection for Cervical Radiculopathy

Cortical Blindness and Neurologic Injury Complicating Cervical Transforaminal Injection for Cervical Radiculopathy

Role of Digital Subtraction Fluoroscopic Imaging in Detecting Intravascular Injections

Complications of unintended intravascular penetration and subsequent injection of local anesthetics and/or other drugs occasionally are devastating. Multiple reports have related to unrecognized intravascular placement of the needle. The generally accepted technique during interventional techniques is intermittent fluoroscopy. In fact, this may miss vascular uptake due to rapid washout. Thus, digital subtraction, the commonly accepted standard for documenting angiography and venography, may be a useful tool for documentation of and/or avoidance of intravascular placement of the needle and subsequent injections with interventional techniques. This case report involves description of digital subtraction to enhance visualization of contrast distribution during injection. Three series of images are included from atlanto-occipital joint, caudal epidural catheterization, and a cervical transforaminal injection. The case reports demonstrate that digital subtraction fluoroscopic imaging is superior to intermittent or live fluoroscopy in detecting intravascular injections with interventional techniques.

Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury

Spinal cord injury has been recognized as a complication of cervical transforaminal injections, but the mechanism of injury is uncertain. In the course of a transforaminal injection, an observation was made after the initial injection of contrast medium. The contrast medium filled a radicular artery that passed to the spinal cord. The procedure was summarily abandoned, and the patient suffered no ill effects. This case demonstrates that despite using careful and accurate technique, it is possible for material to be injected into a radicular artery. Consequently, inadvertent injection of corticosteroids into a radicular artery may be the mechanism for spinal cord injury following transforaminal injections. This observation warns operators to always perform a test injection of contrast medium, and carefully check for arterial filling using real-time fluoroscopy with digital subtraction.