Waseem Amir Bashir MBChB, Presenter: Nothing to Disclose

Faisal Alyas MBBS, Abstract Co-Author: Nothing to Disclose

David Alister Connell MBBS, Abstract Co-Author: Nothing to Disclose

Cervical root pain is a common problem leading to severe debilitating pain. Treatment is mainly conservative with physical therapy and analgesia. In chronic cases more invasive methods of therapy include techniques using ionising radiation such as fluoroscopic & CT guided interlaminar and transforaminal epidural steroid injections (TF-ESIs) as well as surgery.

This pilot study involved 20 patients who were referred to the radiology department after appropriate anaesthetic and surgical assessment as to the requirement for cervical TF-ESIs. Normally the patients would have undergone fluoroscopic or CT guided injection but were enrolled in this study after fully informed written consent. A 25 gauge echogenic spinal needle was advanced under sonographic guidance to a transforaminal position – nerve root levels were mapped by first identifying the C7 transverse processes and then counting transverse processes and nerve roots cranially. The nerve root under investigation clearly showed thickening and was bathed in non-particulate corticosteroid and 0.5% bupivacaine in standard dosage.  

Visual analogue pain scores (VAS) were completed pre- and 30 minutes post-procedure. Further follow-up VAS was performed at 4 weeks post therapy. All patients had a significant reduction in pain scores at 4 weeks with sonographic evidence of reduction in nerve root thickness. No complications were reported or detected during this study.

Cervical TF-ESIs and cervical selective nerve root blocks are currently performed under fluoroscopic or CT guidance. Unfortunately, there is increasing literature illustrating the potential for brain and spinal cord infarction following cervical TF-ESIs. Ultrasound avoids the risks of ionising radiation. Sonographic guidance allows accurate real-time visualisation with high resolution of local anatomy and needle trajectory. Most importantly needle tip position is seen clearly. Colour Doppler allows scrutiny of vascular flow and therefore the investigator can have greater confidence in avoiding intravascular injection. Ultrasound guided nerve root injection is therefore a feasible and effective therapy for patients with refractory cervical radiculopathy symptoms.

With fluoroscopy and non-contrast CT, one cannot see vascular structures with total confidence. We have shown that US can be used safely to provide pain relief in cervical radiculopathy patients.

Bashir, W, Alyas, F, Connell, D, Ultrasound-guided Cervical Transforaminal Epidural Nerve Root Injection: A Novel Minimally Invasive Safe Technique for Management of Cervical Radiculopathy.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6014538.html