Top

European Spine Journal

Published in:

01-05-2013 | Case Report

Must we discontinue selective cervical nerve root blocks?

Report of two cases and review of the literature

Authors: Juerg Hodler, Norbert Boos, Martin Schubert

Published in: European Spine Journal | Special Issue 3/2013

Abstract

We report two detrimental neurologic complications after technically correct selected cervical nerve root blocks. Based on these cases and a thorough review of the literature, the indication for cervical nerve root blocks was reconsidered and limited. Similarly, we modified our technique to further reduce the likelihood for the occurrence of such severe complications.

Benedetti EM, Siriwetchdarek R, Stanec J, Rosenquist R (2009) Epidural steroids injections: complications and management. Tech Reg Anesth 13:236–250

Berger O, Dousset V, Delmer O, Pointillart V, Vital JM, Caille JM (1999) Evaluation of the efficacy of foraminal infusions of corticosteroids guided by computed tomography in the treatment of radicular pain by foraminal injection. J Radiol 80:917–925PubMed

Bogduk N, Dreyfuss P, Baker R, Yin W, Landers M, Hammer M, Aprill C (2008) Complications of spinal diagnostic and treatment procedures. Pain Med 9:S11–S34CrossRef

Brouwers PJ, Kottink EJ, Simon MA, Prevo RL (2001) A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91:397–399PubMedCrossRef

Candido KD, Ghaly RF, Mackerley S, Knezevic NN (2010) A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections. South Med J 103:679–682PubMedCrossRef

Furman MB, Giovanniello MT, O’Brien EM (2003) Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976) 28:21–25CrossRef

Heavner JE, Racz GB, Jenigiri B, Lehman T, Day MR (2003) Sharp versus blunt needle: a comparative study of penetration of internal structures and bleeding in dogs. Pain Pract 3:226–231PubMedCrossRef

Huntoon MA (2005) Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain 117:104–111PubMedCrossRef

Karasek M, Bogduk N (2004) Temporary neurologic deficit after cervical transforaminal injection of local anaesthetic. Pain Med 5:202–205PubMedCrossRef

10.

Leonardi M, Pfirrmann CW (2008) Spinal injections. In: Aebi M, Boos N (eds) Spinal disorders. Fundamentals of diagnosis and treatment. Springer, Heidelberg, pp 261–290CrossRef

11.

Leonardi M, Pfirrmann CW, Boos N (2006) Injection studies in spinal disorders. Clin Orthop Relat Res 443:168–182PubMedCrossRef

12.

Marino RJ, Barros T, Biering-Sorensen F, Burns SP, Donovan WH, Graves DE, Haak M, Hudson LM, Priebe MM (2003) International standards for neurological classification of spinal cord injury. J Spinal Cord Med 26(Suppl 1):S50–S56PubMed

13.

Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, Guarino AH, Moran CJ, Riew KD (2008) Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Jt Surg Am 90:1932–1938CrossRef

14.

Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, Broadbent P, Myers ME, Shrack K (2009) Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol 30:507–511PubMedCrossRef

15.

Rathmell JP, Aprill C, Bogduk N (2004) Cervical transforaminal injection of steroids. Anesthesiology 100:1595–1600PubMedCrossRef

16.

Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, Dominick J, Wecht CH (2003) Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24:351–355PubMedCrossRef

17.

Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS (2007) Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine (Phila Pa 1976) 32:1249–1256CrossRef

18.

Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ (2000) 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 81:741–746PubMed

19.

Strobel K, Pfirrmann CW, Schmid M, Hodler J, Boos N, Zanetti M (2004) Cervical nerve root blocks: indications and role of MR imaging. Radiology 233:87–92PubMedCrossRef

20.

Suresh S, Berman J, Connell DA (2007) Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skelet Radiol 36:449–452CrossRef

21.

Vallee JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallee CA (2001) Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology 218:886–892PubMed

22.

Wolter T, Mohadjer M, Berlis A, Knoeller S (2009) Cervical CT-guided, selective nerve root blocks: improved safety by dorsal approach. AJNR Am J Neuroradiol 30:336–337PubMedCrossRef

Title: Must we discontinue selective cervical nerve root blocks?
Report of two cases and review of the literature
Authors: Juerg Hodler
Norbert Boos
Martin Schubert
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue Special Issue 3/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2642-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Must we discontinue selective cervical nerve root blocks?

Report of two cases and review of the literature

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 3/2013

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

Erratum to: Surgical management of primary spinal hemangiopericytomas: an institutional case series and review of the literature

Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear?

Thoracolumbar intramedullary subependymoma with multiple cystic formation: a case report and review

Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta

Duplication of spine with hemi-lipomyelomeningocele