Selective Nerve Root Block, Cervical Spine

KEY FACTS

Terminology

• Selective anesthesia of cervical nerve root at level of neural foramen

Preprocedure

• Radiculopathy corresponding to cervical dermatome

Procedure

• Target

  • Superior articular process of same number vertebra as nerve being injected (nerve comes out 1 level above)

  • At level of superior articular facet, deflect needle anteriorly into neural foramen

  • Verify needle tip placement within neural foramen in frontal and lateral projections

• Slowly inject iodinated contrast to confirm correct needle placement if no contraindication

  • Should see contrast track along nerve root

  • May see contrast track beneath pedicle and into epidural space (transforaminal epidural steroid injection)

  • Should not see vascular enhancement, contrast pooling, or feathering within skeletal muscle

  • Use nonparticulate steroid preparation to minimize vascular complications

• Alternative procedure: Interlaminar epidural steroid injection

Post Procedure

• Pain assessment

  • Note pain before, during, and after injection and whether characteristic pain was reproduced

Outcomes

• Vasovagal reaction

• Most feared complications

  • Stroke, spinal cord puncture, hematoma

TERMINOLOGY