title: Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.
abstract: BACKGROUND
  A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution.
  
  
  METHODS
  Between October 1999 and June 2003, we performed 1036 fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients. Plain radiographs documenting the procedure were made as part of the standard quality-assurance protocol. An independent observer who was uninvolved with the procedures reviewed a prospectively kept database on all patients. We subsequently reviewed the patient records to identify complications.
  
  
  RESULTS
  There were no catastrophic complications such as vessel damage, paralysis, or death. Overall, fourteen patients (1.66%) had a minor complication in association with the procedure. With the numbers available, the rate of complications associated with pdeep injection (798 blocks) was not significantly different from that associated with shallow injection (238 blocks) (1.89% compared with 0.84%). However, the rate of complications associated with anterior placement of the needle tip (thirty-three blocks) was higher than that associated with ideal placement of the needle tip (904 blocks) (6.06% compared with 1.55%) (p = 0.04).
  
  
  CONCLUSIONS
  No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures.
authors.affiliation: Department of Radiology and the Cervical Spine Service, Barnes-Jewish Hospital at Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8131, Campus Box 8233, and Campus Box 8021, St. Louis, Missouri 63110, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ma
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gilula
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage; D002574:Cervical Vertebrae; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy; D009407:Nerve Block / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D001623:Betamethasone