Cervical Transforaminal Epidural Steroid Injection

Chapter 28 Cervical Transforaminal Epidural Steroid Injection



Ruby E. Kim, Michael B. Furman


Cervical transforaminal epidural steroid injections are indicated to relieve radicular symptoms with or without axial neck pain from cervical nerve root irritation. The traditional approach to the epidural space was interlaminar. The transforaminal epidural steroid injection is used to deliver the injectate to the ventral epidural space where the pain generators are located: the posterior annulus, the ventral aspect of the nerve root sleeve, and the neural foramen.1,2


Neurovascular risks for this procedure are high, with known complications thought to be caused by the intravascular injection of particulate steroid, thereby resulting in the embolism of vascular structures with infarction.3–6 Digital subtraction is strongly advised to increase sensitivity to the detection of vascular contrast flow. Note that the trajectory (oblique) view is also one of the multiplanar views. This procedure may be performed in the supine position as demonstrated in this chapter or in the lateral decubitus position.


Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.



image Trajectory View (Figure 28–1)



image image image

Figure 28–1 A, Fluoroscopic image of the trajectory view with the needle tip in position at the posterior aspect of the C5-6 foramen. B, Radiopaque structures, trajectory view. C, Radiolucent structures, trajectory view.



image Safety Considerations


It is imperative that the needle tip be located at the dorsal and posterior aspect of the intervertebral foramen to avoid vertebral artery puncture.



image The Trajectory View (Foraminal Oblique) Is Also a Multiplanar View




image The patient is positioned supine. Confirm the level with a posteroanterior view by counting down from the C2-3 intervertebral foramen.


image Oblique the C-arm image intensifier approximately 45 degrees toward the symptomatic side (the right side, in this case) to optimally maximize the size of the intervertebral foramen.


image Tilt the C-arm image intensifier to square off the superior endplate of the vertebral body.


image Adjust the obliquity and the tilt to optimally enlarge the size of the intervertebral foramen.


image This angle is used for entry. Because this is the trajectory view, the needle-entry position should be parallel to the C-arm beam.


image The needle-tip destination is the dorsal and posterior aspect of the intervertebral foramen to avoid vertebral artery penetration.



image Optimal Views in Multiplanar Imaging


Related posts:

Atlantoaxial Joint Intraarticular Injection Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach Thoracic Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Discography/Disc Access

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Cervical Transforaminal Epidural Steroid Injection

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