Article Figures & Data
Figures
- Fig 1.
The foraminal angle is 50°. White arrow demonstrates the vertebral artery.
- Fig 2.
A, Patient positioned obliquely on a 45° wedge for right-sided injection. B, The patient positioned supine for right-sided injection with the proceduralist using fluoroscopy to position the clamp before marking the skin. Table and C-arm are raised to eye-level to facilitate proceduralist visualization during the procedure.
- Fig 3.
Contrast syringe connected via 2 short, low-volume tubing to the hub of the 25-ga spinal needle. The patient is positioned for a left-sided injection.
- Fig 4.
Curved clamp tip placed gently on the skin overlying the posterior-inferior aspect of neural foramen for optimal location, taking care to avoid indenting the skin surface.
- Fig 5.
Ideal needle position in the posterior-inferior corner of the neural foramen (A, arrow) and acceptable needle position (B, arrow).
- Fig 6.
Needle tip advanced to the edge of the lateral mass on the anterior-posterior projection (arrow).
- Fig 7.
Contrast in the perineural space along the right C6 nerve root (A, arrow) and clearly outlining the left C7 nerve root (B, arrow). Either result is acceptable.
- Fig 8.
Vascular filling demonstrated during live injection (arrows) requiring needle repositioning.
- Fig 9.
Syringe containing 1 mL of dexamethasone, 10 mg/mL; 1 mL of 1% lidocaine; and a small amount of air connected to the remaining tubing segment closest to the hub. The syringe should be held so that the air floats anti-dependently during the injection, not horizontally as shown in this picture, which was taken before injection.
- Fig 10.
Flow chart demonstrates the effectiveness of CF-SCNRB with regard to postprocedural pain assessment at 15 minutes and 2 weeks.
Tables
Study Population Male Female Average age (yr) 51.5 50.2 No. 123 131 Percentage 48.4% 51.6% Level of Injection No. of Patients C4 9 C5 25 C6 115 C7 76 C8 29 No. of Patients Primary outcomes >50% pain relief at 15 min 185 (75.2%) <50% pain relief at 15 min 61 (24.8%) >50% pain reduction from baseline at 2 wk 165 (67.1%) <50% pain reduction from baseline at 2 wk 81 (32.9%) No preprocedural pain (patient-reported numbness or paresthesia) 8 (3.1%) Alleviation of preprocedural numbness or paresthesia at 2 wk 7 of 8 (87.5%) Minor adverse reactions or events Vasovagal reaction 3 (1.2%) Transient pseudo-Horner syndrome (sympathetic blockade) 1 (0.4%) New onset of diffuse headache 2 (0.8%) Increase in usual pain in a familiar distribution 8 (3.1%) ↵a Transient arm numbness postinjection was not included as an untoward effect because it is expected when exposing cervical nerve roots to a lidocaine containing mixture.
Approximate Corresponding Radiation Incurred CT-guided average effective dose 0.36 ± 0.41 mSv CF average fluoroscopy time of 24.3 sec 0.17 mSv ↵a Average CT-guided effective dose was calculated from dose-length product values reported by Lazarus et al11 over 228 SCNRB cases using a conversion factor of 5.4 uSv/mGy × cm for cervical spine examinations developed by Huda et al.21 CF radiation dose is referenced and extrapolated from a direct comparison by Schmid et al27 using an Alderson Rando phantom.
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