Selective Nerve Root Block, Thoracic Spine



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


  • Indications

    • Thoracic radiculopathy

    • Persistent pain after vertebroplasty/kyphoplasty

    • Neoplastic compression of thoracic nerve root


  • 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


  • 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

Cervical Root Numbering

Vertebral Body Numbering

Foraminal Injection: Transforaminal Epidural Steroid Injection

Needle Placement: CT


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