Transforaminal Selective Nerve Root Blocks for Treating Single Lumbosacral Radiculopathy: The Short-term Outcome and Efficiency / 대한정형외과학회잡지

PURPOSE: We wanted to determine the clinic usefulness of selective nerve root block for treating lumbosacral radiculopathy that's due to a herniated nucleus pulposus (HNP) or foraminal stenosis (FS) by analyzing the short-term results after the selective nerve root block (SNRB) procedure. MATERIALS AND METHODS: Sixty-five patients were investigated in our research. Sixty-five patients were divided into two groups: thirty-seven patients of group one were the HNP patients and twenty-eight patients of group two were the FS patients. The effect of SNRB treatment was assessed by the degree of radiating pain in lower legs with using the visual analogue scale (VAS) and patients' subjective satisfaction. The average overall follow-up period was eleven months: that of the first group was 13.5 months and that of the group was 7.6 months. RESULTS: For the 65 patients, the average VAS was 7.8 before a SNRB procedure and this decreased to 2.9 and 3.4 after one to three SNRB procedures, respectively. For group one, the VAS was 7.4 before the procedure and it decreased to 3.3 at one month and 3.7 at three months after the procedure. For group two, the VAS was 8.3 before the SNRB procedure and this favorably changed to 2.3 at one month and 3.0 at three months after the procedure. An operation was carried out due to no response for 8 patients (12%) and due to aggravation for 4 patients (6%) after the SNRB procedures. Three patients (8%) of group one and two patients (11%) of group two obtained pain relief at one month and aggravation at three months, respectively. On comparing the two groups, a better treatment effect was observed for the FS group after one month (p=0.002) and three months (p=0.01). Complications related to the SNRB procedure haaves not been observed in both groups. CONCLUSION: The SNRB procedure is a very effective and safe procedure, after the appearance of symptoms, as a non-operative treatment for single lumbosacral radiculopathy due to a herniated nucleus pulposus or foraminal stenosis. This treatment appears to be more effective for the FS group than for the HNP group and it should be considered before carrying out an operative treatment.

CT Guided Cervical Transforaminal Steroid Injection: 2 Months Follow-up / 대한통증학회지

BACKGROUND: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. METHODS: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. RESULTS: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. CONCLUSIONS: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

CT Guided Cervical Transforaminal Steroid Injection for the Elderly Patient with Enlarged Internal Jugular Vein and Vertebral Artery: A case report / 대한마취과학회지

Seventy nine-year old female patient visited our department presenting radicular pain on her neck, left shoulder and arm. She had a history of hypertension and underwent coronary angiography and angioplasty 4 years ago. Cervical MRI showed central disc herniation with osteophyte and left foraminal stenosis at C5-6 level and bulging disc with osteophyte and foraminal stenosis (left > right) at C6-7. First plan was transforaminal steroid injection under C-arm fluoroscopy at C5-6 level. Unexpectedly, we could find enlarged internal jugular vein and vertebral artery on MRI scan, which is due to cardiovascular disease. These important vascular structures were expected to be injured by needle during the procedure if done under C-arm fluoroscopy. We decided to give transforaminal steroid injection under CT fluoroscopy to avoid injury to the large vessels and inadvertent complication. The procedure was successfully done using CT fluoroscopy (Brilliance 10(TM), Philips(R), USA) without any complication associated with vascular injury or intravascular injection.