Selective Cervical Nerve Root Blockade: Prospective Study of Immediate and Longer Term Complications

• Published in: American journal of neuroradiology : AJNR 2009-03, Vol.30 (3), p.507-511
• Main Authors: Pobiel, R.S, Schellhas, K.P, Eklund, J.A, Golden, M.J, Johnson, B.A, Chopra, S, Broadbent, P, Myers, M.E, Shrack, K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anatomy; Anesthetics, Local - administration & dosage; Biological and medical sciences; Central nervous system; Cervical Vertebrae; Female; Fluoroscopy; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Nervous system; Outpatients; Prospective Studies; Radiculopathy - diagnostic imaging; Radiculopathy - drug therapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Spinal Nerve Roots - diagnostic imaging; Spine; Treatment Outcome; Vertebrates: nervous system and sense organs
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1415

Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB. Eight hundred two consecutive fluoroscopically guided diagnostic and/or therapeutic SCNRBs in 659 patients were performed during a 14-month period (November 2006-December 2007) at affiliated outpatient imaging centers. Each examination was performed by 1 of 8 experienced procedural radiologists by using an anterior oblique approach, with the needle position confirmed with radiographic contrast before injection of an admixture of local anesthetic and steroid. All patients were assessed immediately and at 30 minutes following the procedure. Additionally, 460 patients were called by telephone 30 days following the procedure. All complications were recorded. Of the 802 attempted procedures, 799 were successfully completed. Three procedures were aborted due to anxiety, challenging body habitus, or persistent venous opacification observed during contrast injection and despite needle repositioning. There were no serious complications, such as stroke, spinal cord insult, permanent nerve root deficit, infection, or significant hematoma. There were 33 minor complications occurring within 30 minutes of the procedure; the most common was vasovagal symptoms. Three hundred forty-five patients were successfully contacted by telephone at 30 days postinjection, 9 of whom reported increased or new pain symptoms. With our technique, fluoroscopically guided SCNRB is a safe outpatient procedure with a low immediate and delayed complication rate.