Abstract
Selective nerve root block by a transforaminal approach with radiological control allows injection of an appropriate corticosteroid next to the nerve root, although it has been associated with major neurological complications in a few cases. There have been several reports in which corticosteroid injections performed at the level of the cervical or lumbar spine have led to severe spinal cord ischemic infarction. These have occurred independently of whether the procedure was performed under radiological control, in which the tip of the needle is identified to prevent vascular spreading of the solution injected.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Huntoon MA. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain. 2005;117:104–11.
Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution. A review of the relative neurotoxicities of the steroids. Anesthesiology. 2007;106:331–8.
Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 2008;9:227–34.
Reina MA, De Andrés JA, Hernández JM, López A, Fernández Domínguez M, Prats-Galino A. Possibility of particulated steroids injection for selective root blocks in the cervical and lumbar regions: anatomical study. Minerva Anestesiol. 2013;79(suppl I):57–61.
Reina MA, De Andrés JA, Hernández JM, Prats-Galino A, Machés F, Peláez J. Transforaminal or translaminar approach for dorsal root ganglion and dorsal nerve root. Anatomical reason for technique decision. Eur J Pain Suppl. 2010;4:287–97.
Gazelka HM, Burgher AH, Huntoon MA, Mantilla CB, Hoelzer BC. Determination of the particulate size and aggregation of clonidine and corticosteroids for epidural steroid injection. Pain Physician. 2012;15:87–93.
Gharibo C, Koo C, Chung J, Moroz A. Epidural steroid injections: an update on mechanisms of injury and safety. Tech Reg Anesth Pain Manag. 2009;13:266–71.
Heavner JE, Racz GB, Jenigiri B, Lehman T, Day MR. Sharp vs blunt needle: a comparative study of penetration of internal structures and bleeding in dogs. Pain Pract. 2003;3:226–31.
Raghavendra M, Patel V. Should we cease performing transforaminal injections? Reg Anesth Pain Med. 2005;30:208–9.
Helm 2nd S, Jasper JF, Racz GB. Complications of transforaminal epidural injections. Pain Physician. 2003;6:389–90.
Smuck M, Tang CT, Fuller BJ. Incidence of simultaneous epidural and vascular injection during cervical transforaminal epidural injections. Spine. 2009;34:E751–5.
Smuck M, Yu AJ, Tang CT, Zemper E. Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles. Spine J. 2010;10:367–71.
Smuck M, Leung D. Inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle. Spine. 2011;36:E220–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Reina, M.A., De Andrés, J.A., Hernández, J.M. (2015). Injections of Particulate Steroids for Nerve Root Blockade: Ultrastructural Examination of Complicating Factors. In: Reina, M., De Andrés, J., Hadzic, A., Prats-Galino, A., Sala-Blanch, X., van Zundert, A. (eds) Atlas of Functional Anatomy for Regional Anesthesia and Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-09522-6_42
Download citation
DOI: https://doi.org/10.1007/978-3-319-09522-6_42
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-09521-9
Online ISBN: 978-3-319-09522-6
eBook Packages: MedicineMedicine (R0)