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Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate long-term pain reduction and ‘improvement’ in patients with indirect cervical nerve-root-blocks in comparison to MRI findings.

Material and Methods

One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and ‘improvement’ at 1-month, 3-months and 1-year post injection.

Results

The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011).

Conclusion

Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions.

Key Points

• Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids.

• The presence of nerve root compression was a predictive finding of ‘improvement’.

• Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection.

• There is less pain relief in patients with disc extrusions.

• There are less improvement in patients with modic type I changes.

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References

  1. Martin BI, Deyo RA, Mirza SK et al (2008) Expenditures and health status among adults with back and neck problems. JAMA 299:656–664

    Article  CAS  PubMed  Google Scholar 

  2. Rao R (2002) Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. J Bone Joint Surg Am 84-A:1872–1881

    PubMed  Google Scholar 

  3. Dreyfuss P, Baker R, Bogduk N (2006) Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med 7:237–242

    Article  PubMed  Google Scholar 

  4. Wagner AL (2005) CT fluoroscopic-guided cervical nerve root blocks. AJNR Am J Neuroradiol 26:43–44

    PubMed  Google Scholar 

  5. Hodler J, Boos N, Schubert M (2013) Must we discontinue selective cervical nerve root blocks? Report of two cases and review of the literature. Eur Spine J 22(Suppl 3):S466–S470

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Baker R, Dreyfuss P, Mercer S, Bogduk N (2003) Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103:211–215

    Article  PubMed  Google Scholar 

  9. 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 91:397–399

    Article  CAS  PubMed  Google Scholar 

  10. Rosenkranz M, Grzyska U, Niesen W et al (2004) Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol 251:229–231

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Tiso RL, Cutler T, Catania JA, Whalen K (2004) Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J 4:468–474

    Article  PubMed  Google Scholar 

  13. Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P (2007) Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol 188:1218–1221

    Article  PubMed  Google Scholar 

  14. Okubadejo GO, Talcott MR, Schmidt RE et al (2008) Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am 90:1932–1938

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  16. Rozin L, Rozin R, Koehler SA et al (2003) Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24:351–355

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Sutter R, Pfirrmann CW, Zanetti M, Hodler J, Peterson CK (2011) CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique. Skeletal Radiol 40:1603–1608

    Article  PubMed  Google Scholar 

  19. Wolter T, Knoeller S, Berlis A, Hader C (2010) CT-guided cervical selective nerve root block with a dorsal approach. AJNR Am J Neuroradiol 31:1831–1836

    Article  CAS  PubMed  Google Scholar 

  20. Klessinger S, Freund W, Karpel-Massler G, Halatsch ME (2014) Response to Transforaminal Injection of Steroids and Correlation to MRI Findings in Patients with Cervical Radicular Pain or Radiculopathy due to Disc Herniation or Spondylosis. Pain Med 15:929–937

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Butterworth JF, Strichartz GR (1990) Molecular mechanisms of local anesthesia: a review. Anesthesiology 72:711–734

    Article  CAS  PubMed  Google Scholar 

  23. Sato C, Sakai A, Ikeda Y, Suzuki H, Sakamoto A (2008) The prolonged analgesic effect of epidural ropivacaine in a rat model of neuropathic pain. Anesth Analg 106:313–320, table of contents

    Article  CAS  PubMed  Google Scholar 

  24. Toda S, Sakai A, Ikeda Y, Sakamoto A, Suzuki H (2011) A local anesthetic, ropivacaine, suppresses activated microglia via a nerve growth factor-dependent mechanism and astrocytes via a nerve growth factor-independent mechanism in neuropathic pain. Mol Pain 7:2

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Bush K, Hillier S (1996) Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J 5:319–325

    Article  CAS  PubMed  Google Scholar 

  26. Desai A, Saha S, Sharma N, Huckerby L, Houghton R (2014) The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability. Skeletal Radiol 43:973–978

    Article  PubMed  Google Scholar 

  27. Kolstad F, Leivseth G, Nygaard OP (2005) Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study. Acta Neurochir (Wien) 147:1065–1070, discussion 1070

    Article  CAS  Google Scholar 

  28. Kremer S, Pfirrmann CW, Hodler J, Peterson CK (2012) Imaging-guided lumbar facet injections: is there a difference in outcomes between low back pain patients who remember to return a postal questionnaire and those who do not? Insights Imaging 3:411–418

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lechmann M, Peterson CK, Pfirrmann CW, Hodler J (2013) Lumbar nerve root injections: a prospective cohort outcomes study comparing age- and gender-matched patients who returned an outcomes-based postal questionnaire with patients who did not return the postal questionnaire. Skeletal Radiol 42:1429–1435

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Susanne Bensler. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective and retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Susanne Bensler, Reto Sutter, Christian W. A. Pfirrmann & Cynthia K. Peterson

  2. Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland

    Susanne Bensler, Reto Sutter, Christian W. A. Pfirrmann & Cynthia K. Peterson

Authors
  1. Susanne Bensler
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  2. Reto Sutter
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  3. Christian W. A. Pfirrmann
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  4. Cynthia K. Peterson
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Corresponding author

Correspondence to Susanne Bensler.

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Bensler, S., Sutter, R., Pfirrmann, C.W.A. et al. Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings- A prospective Study. Eur Radiol 25, 3405–3413 (2015). https://doi.org/10.1007/s00330-015-3758-4

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  • DOI: https://doi.org/10.1007/s00330-015-3758-4

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