Clinical noteIntravascular Uptake During Fluoroscopically Guided Cervical Interlaminar Steroid Injection at C6-7: A Case Report
Section snippets
Procedure Description
We used a down the barrel, hanging drop technique in all 4 cases. The patient was placed in a prone position with the neck flexed and the chest supported with a pillow to give greater access to the cervical interlaminar space. We determined the skin entry point by placing a curved metal hemostat on the patient’s skin surface and then aligning the tip of the hemostat with the target interspace. Local anesthesia was administered with a bent, 1.5-in, 25-gauge needle. The needle was removed and
Discussion
This case series describes the intravascular spread of contrast we observed when performing interlaminar ESIs at the C6-7 level in 4 patients. The technical issues raised by this finding include determining which vessels are involved, how one can avoid penetrating them when using the interlaminar approach, and how useful as a predictive tool is negative aspiration of blood for intravascular needle placement. The clinical consideration is whether there are any potential adverse effects of direct
Conclusions
With the increasing popularity of the interlaminar approach in cervical steroid injection, it is reasonable to assume that intravascular uptake will occur with greater frequency. The low sensitivity and poor negative predictive value of negative aspiration of blood in potential intravascular uptake calls for the use of fluoroscopy techniques, including the administration of contrast, to guide the correct placement of the needle. The risks of adverse sequelae resulting from venous intravascular
References (15)
- et al.
Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids
Spine J
(2004) - et al.
Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury
Pain
(2003) Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections
Pain
(2005)- et al.
Complications of fluoroscopically guided interlaminar cervical epidural injections
Arch Phys Med Rehabil
(2003) Quadriparesis following cervical epidural steroid injections: case report and review of the literature
Spine J
(2005)- et al.
Quadriparesis following cervical epidural steroid injections
Spine J
(2006) - et al.
A 67-year-old woman with abnormal lung perfusion scan
Chest
(2004)
Cited by (22)
Epidural steroid injections: Evidence and technical aspects
2010, Techniques in Regional Anesthesia and Pain ManagementCitation Excerpt :This method could not prevent the appearance of two cases of accidental dural puncture. The use of fluoroscopy enables detection through the use of contrast dye of potential complications that would not be detectable by using ultrasound, such as small vascular punctures, even with the classic translaminar boarding,53 which is considered safe by the majority of interventionists. Synthesizing all the information presented above, the use of fluoroscope guidance in performing procedures of ESI seems to be preferable, leaving other image guidance methods for the occasions when difficulties exist with administering fluoroscopy.
Epidural steroid injections: Complications and management
2009, Techniques in Regional Anesthesia and Pain ManagementCitation Excerpt :Aggregate particles of this size can potentially place large blocks of neural tissue at risk for injury or infarction. Kaplan and coworkers146 reported four cases of venous uptake of contrast material during fluoroscopically guided cervical interlaminar ESI at the C6-C7 level. The blood vessel involved is most likely the posterior internal vertebral venous plexus, which drains the interlaminar space and returns blood to the right atrium via the vertebral and brachiocephalic veins.
American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement
2022, Regional Anesthesia and Pain MedicineUltrasound-guided cervical selective nerve root injections: A narrative review of literature
2021, Regional Anesthesia and Pain MedicineCervical Ultrasound Utilization in Selective Cervical Nerve Root Injection for the Treatment of Cervical Radicular Pain: a Review
2019, Current Physical Medicine and Rehabilitation Reports
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
Reprints are not available from the author.