Paravertebral Collateral Arteries in Patients with Carotid Stenosis: Is There a Safe Space for Transforaminal Cervical Nerve Root Injections?
- 11 Downloads
Image-guided cervical nerve root injections can cause serious complications including spinal cord infarction. This risk may be increased in patients with carotid stenosis who develop collateral arteries. The aim of this study is to describe the prevalence, and anatomical location, of arterial collateral vessels in relation to the optimal needle tip position in cervical nerve root injections.
Materials and Methods
This retrospective study included 25 patients who had > 70% stenosis on a carotid CT angiogram. For each foramen the position of collateral arteries and the most anterior point of the facet joint were recorded, as Cartesian coordinates, by two independent observers. Descriptive statistics were used to analyse and present the results.
14 patients had unilateral and 11 had bilateral stenoses. A total of 85 collaterals were identified at all levels, the most common being C2/3. The median distance from collateral to optimal needle tip placement was 9.6 mm (95% CI median: 6.7–12.4, IQR: 5.6–15.6). The minimum distance was 2.9 mm. Inter-observer reliability was “substantial” (ICC 0.78, 95% CI 0.71–0.83).
Collateral arteries were common in our cohort of patients with carotid artery stenosis and half lay within 10 mm of the optimal position for transforaminal cervical nerve root injection.
KeywordsCervical nerve root injections Carotid stenosis Cervical collaterals Optimal needle tip position
APT: Guarantor of integrity of the entire study. APT, AF: Study concepts and design. AM: Literature search. Clinical studies—N/A. AM, AES: Experimental studies/data analysis. APT: Statistical analysis. AM, AES, APT: Manuscript preparation APT: Manuscript editing.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Lee MH, Cha YD, Song JH, An YM, Han JU, Lee DI. Transient quadriplegia after fluoroscopic-guided selective cervical nerve root block in a patient who received cervical interbody fusion-a case report. Korean J Anesthesiol. 2010;59(Suppl):S95–8. https://doi.org/10.4097/kjae.2010.59.S.S95.Google Scholar
- 8.Bacci D, Valecchi D, Sgambati E, et al. Compensatory collateral circles in vertebral and carotid artery occlusion. Ital J Anat Embryol. 2008;113(4):265–71.Google Scholar
- 10.R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2013.Google Scholar
- 11.Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.Google Scholar
- 15.Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA, Pobiel RS. Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement. AJNR Am J Neuroradiol. 2007;28(10):1909–14. https://doi.org/10.3174/ajnr.A0707.Google Scholar
- 16.Kelekis A, Filippiadis DK, Velonakis G, Martin JB, Oikonomopoulos N, Brountzos E, Kelekis N. Fluoroscopically guided infiltration of the cervical nerve root: an indirect approach through the ipsilateral facet joint. Pain Physician. 2014;17(4):291–6.Google Scholar