The Journal of Bone and Joint Surgery (American). 2005;87:1025-1030.
doi:10.2106/JBJS.D.02139
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 Pain Management Test 4: Winter 2008 (publication date February 15, 2008; ex...
CME 2: April, May, June 2005
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ma, D. J.
Right arrow Articles by Riew, K. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ma, D. J., III
Right arrow Articles by Riew, K. D.
Related Collections
Right arrow Spine
Right arrow Pain Management
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Complications of Fluoroscopically Guided Extraforaminal Cervical Nerve Blocks

An Analysis of 1036 Injections

Daniel J. Ma, III, MS1, Louis A. Gilula, MD1 and K. Daniel Riew, MD1

1 Departments of Radiology (L.A.G.) and Orthopaedic Surgery (K.D.R.), and School of Medicine (D.J.M.), Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8131 (L.A.G.), Campus Box 8233 (K.D.R.), and Campus Box 8021 (D.J.M.), St. Louis, MO 63110

Investigation performed at the Department of Radiology and the Cervical Spine Service, Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution.

Methods: Between October 1999 and June 2003, we performed 1036 fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients. Plain radiographs documenting the procedure were made as part of the standard quality-assurance protocol. An independent observer who was uninvolved with the procedures reviewed a prospectively kept database on all patients. We subsequently reviewed the patient records to identify complications.

Results: There were no catastrophic complications such as vessel damage, paralysis, or death. Overall, fourteen patients (1.66%) had a minor complication in association with the procedure. With the numbers available, the rate of complications associated with pdeep injection (798 blocks) was not significantly different from that associated with shallow injection (238 blocks) (1.89% compared with 0.84%). However, the rate of complications associated with anterior placement of the needle tip (thirty-three blocks) was higher than that associated with ideal placement of the needle tip (904 blocks) (6.06% compared with 1.55%) (p = 0.04).

Conclusions: No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Am. J. Neuroradiol.Home page
K.P. Schellhas, S.R. Pollei, B.A. Johnson, M.J. Golden, J.A. Eklund, and R.S. Pobiel
Selective Cervical Nerve Root Blockade: Experience with a Safe and Reliable Technique Using an Anterolateral Approach for Needle Placement
AJNR Am. J. Neuroradiol., November 1, 2007; 28(10): 1909 - 1914.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. Y. Lee, A. Nassr, and R. K. Ponnappan
Epidural Hematoma Causing Paraplegia After a Fluoroscopically Guided Cervical Nerve-Root Injection. A Case Report
J. Bone Joint Surg. Am., September 1, 2007; 89(9): 2037 - 2039.
[Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
L. A. Gilula and D. Ma
A Cervical Nerve Block Approach to Improve Safety
Am. J. Roentgenol., September 1, 2007; 189(3): 563 - 565.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. A. Munir, R. Rastogi, and S. Nedeljkovic
Fluoroscopy and safety of spinal interventional procedures.
Anesth. Analg., May 1, 2006; 102(5): 1586 - 1586.
[Full Text] [PDF]