2024 年 39 巻 1 号 p. 26-34
Background: While severe complications after cervical selective nerve root block (CSNRB) with an anterolateral approach have been reported, CSNRB via a posterolateral approach (PL–CSNRB) could reduce inadvertent intravascular injections. Because fluoroscopy–guided PL–CSNRB is technically difficult, PL–CSNRBs are often CT– or ultrasound–guided. CT guidance is safe but time–consuming and has a higher risk of radiation exposure. Ultrasound guidance can visualize the vessels but whether it reduces intravascular injections remains debatable.
Purpose: This study described CSNRB using a fluoroscopy–guided posterolateral oblique technique (PLO–CSNRB) and assessed its clinical usefulness.
Methods: A total of 707 PLO–CSNRBs were performed on 260 patients (186 cervical diseases and 74 cervical zoster–associated pain; CZAP) between May 2016 and December 2020. Under fluoroscopy guidance, a needle was inserted posterolaterally and kept in contact with the articular pillar and advanced toward the exit of the intervertebral foramen (C3–C8). A block was considered successful if the intervertebral foramen was filled with contrast (foraminal filling; FF).
Results: The success rate was 94.5% (668/707). The main contrast pattern observed with FF was periradiculography (619) followed by transforaminal epidurography (233). Venography was observed in 135 (19.1%) injections with 52 (38.5%) simultaneously observed with FF. Contrast in the radicular and vertebral arteries was respectively observed in 4 and 2 injections, which disappeared after needle reposition. The effective rates were 83.9% and 55.1% for cervical diseases and CZAP, respectively. No serious complications were noted.
Conclusions: PLO–CSNRB is a useful technique that ensures safe needle advancement to the nerve root at the exit of the intervertebral foramen.