Selective Nerve Root Block, Thoracic Spine

KEY FACTS

Terminology

• Selective corticosteroid and long-acting anesthetic injection of thoracic nerve root at level of neural foramen

Preprocedure

• Indications

  • Thoracic radiculopathy

  • Persistent pain after vertebroplasty/kyphoplasty

  • Neoplastic compression of thoracic nerve root

Procedure

• Use nonparticulate steroid to minimize vascular risk

• C-arm angulation must permit visualization of medial pleural surface of lung during procedure

• CT offers improved soft tissue and lung visualization

  • Sagittal/coronal reformatted CT may facilitate difficult needle placement

Post Procedure

• Report pain intensity before, during, and after injection

Outcomes

• Expected: Significant improvement in pain

• Potential problem: Failure of pain relief

  • Technical failure: Injection not properly localized or wrong level injected

  • Clinical failure: Thoracic nerve root not sole pain generator

• Most feared complications

  • Vascular injury

    • –

      Spinal cord ischemia from compromise of artery of Adamkiewicz

  • Pneumothorax, dural puncture

  • Spinal cord puncture or compression secondary to hematoma

TERMINOLOGY