Skeletal Radiology

, Volume 40, Issue 12, pp 1603–1608 | Cite as

CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

  • Reto Sutter
  • Christian W. A. Pfirrmann
  • Marco Zanetti
  • Juerg Hodler
  • Cynthia K. PetersonEmail author
Technical Report



To describe an “indirect” cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the “direct” cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures.

Materials and methods

The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009–2010 were age- and gender-matched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20–30 min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student’s t test.


Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P = 0.455). No immediate or late adverse effects were reported after either injection procedure.


The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods.


Nerve Root Ropivacaine Facet Joint Cervical Nerve Root Facet Joint Injection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The study was funded by the Vontobel-Stiftung, Tödistrasse 17, 8002 Zürich, Switzerland.


  1. 1.
    Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000;81:741–6.CrossRefGoogle Scholar
  2. 2.
    Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 2006;7:237–42.CrossRefGoogle Scholar
  3. 3.
    Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections. More dangerous than we think? Spine. 2007;32:1249–56.CrossRefGoogle Scholar
  4. 4.
    Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976–1990. Brain. 1994;117:325–35.CrossRefGoogle Scholar
  5. 5.
    Strobel K, Pfirrmann CWA, Schmid M, Hodler J, Boos N, Zanetti M. Cervical nerve root blocks: indications and role of MR imaging. Radiology. 2004;233:87–92.CrossRefGoogle Scholar
  6. 6.
    Vallée JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallée CA. Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology. 2001;218:886–92.CrossRefGoogle Scholar
  7. 7.
    Windsor RE, Storm S, Sugar R, Nagula D. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician. 2003;6:457–65.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine. 2008;33(Suppl):S153–69.CrossRefGoogle Scholar
  9. 9.
    Huntoon MA. Cervical spine: case presentation, complications, and their prevention. Pain Med. 2008;9:S35–40.CrossRefGoogle Scholar
  10. 10.
    Baker R, Dreyfuss P, Mercer S, Bogduk N. Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain. 2003;103:211–5.CrossRefGoogle Scholar
  11. 11.
    Brouwers PJAM, Kottink EJBL, Simon MAM, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. 2001;91:397–9.CrossRefGoogle Scholar
  12. 12.
    Rosenkranz M, Grzyska U, Niesen W, Fuchs K, Schummer W, Weiller C, et al. Anterior spinal artery syndrome following periradicular cervical nerve root therapy. J Neurol. 2004;251:229–31.CrossRefGoogle Scholar
  13. 13.
    Karasek M, Bogduk N. Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med. 2004;5:202–5.CrossRefGoogle Scholar
  14. 14.
    Tiso RL, Cutler T, Catania JA, Whalen BS, Pharm BCPS. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004;4:468–74.CrossRefGoogle Scholar
  15. 15.
    Wallace MA, Fukui MB, Williams RL, Ku A, Baghai P. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol. 2007;188:1218–21.CrossRefGoogle Scholar
  16. 16.
    Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am. 2008;90:1932–8.CrossRefGoogle Scholar
  17. 17.
    Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol. 2007;36:449–52.CrossRefGoogle Scholar
  18. 18.
    Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003;24:351–5.CrossRefGoogle Scholar
  19. 19.
    Furman MB, Giovanniello MT, O’Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. 2003;28:21–5.CrossRefGoogle Scholar
  20. 20.
    Rao R. Neck Pain, Cervical radiculopathy and cervical myelopathy. Pathophysiology, natural history and clinical evaluation. J Bone Joint Surg Am. 2002;84-A:1872–81.CrossRefGoogle Scholar
  21. 21.
    Wagner AL. CT fluoroscopic-guided cervical nerve root blocks. Am J Neuroradiol. 2005;26:43–4.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Pfirrmann CW, Oberholzer PA, Zanetti M, Boos N, Trudell DJ, Resnick D, et al. Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectiveness—a study with patients and cadavers. Radiology. 2001;221:704–11.CrossRefGoogle Scholar
  23. 23.
    Wolter T, Mohadjer M, Berlis A, Knoeller S. Cervical CT-guided, selective nerve root blocks: improved safety by dorsal approach. Am J Neuroradiol. 2009;30:336–7.CrossRefGoogle Scholar
  24. 24.
    Wolter T, Knoeller S, Berlin A, Hader C. CT-guided cervical selective nerve root block with a dorsal approach. Am J Neuroradiol. 2010;31:1831–6.CrossRefGoogle Scholar
  25. 25.
    Hechelhammer L, Pfirrmann CW, Zanetti M, Hodler J, Boos N, Schmid MR. Imaging findings predicting the outcome of cervical facet joint blocks. Eur Radiol. 2007;17:959–64.CrossRefGoogle Scholar
  26. 26.
    Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.PubMedPubMedCentralGoogle Scholar

Copyright information

© ISS 2011

Authors and Affiliations

  • Reto Sutter
    • 1
  • Christian W. A. Pfirrmann
    • 1
  • Marco Zanetti
    • 2
  • Juerg Hodler
    • 3
  • Cynthia K. Peterson
    • 1
    Email author
  1. 1.Department of RadiologyOrthopaedic University Hospital of BalgristZürichSwitzerland
  2. 2.Department of RadiologyHirslanden HospitalZürichSwitzerland
  3. 3.Department of RadiologyUniversity HospitalZürichSwitzerland

Personalised recommendations