title: Cervical foraminal selective nerve root block: a 'two-needle technique' with results.
abstract: Several techniques have been described for selective nerve root blocks. We describe a novel 'two-needle technique', performed through the postero-lateral route with the patient in lateral position under C-arm guidance. The aim of the current study is to highlight the effectiveness and safety of cervical selective nerve root block for radiculopathy using this technique. We present results of a retrospective 2-year follow-up study of 33 injections carried out on 33 patients with radiculopathy due to cervical disc disease and or foraminal stenosis using this procedure. Patients with myelopathy, gross motor weakness and any other pathology were excluded. The outcome was measured comparing 'Visual Analogue Score' (VAS) and 'Neck Disability Index' (NDI) before the procedure with those at 6 weeks and 12 months after the procedure. Thirty patients were included in the final analysis. Average pre-operative VAS score was 7.4 (range 5-10), which improved to 2.2 (range 0-7) at 6 weeks and 2.0 (range 0-4) at 1 year and the mean NDI score prior to intervention was 66.9 (range 44-84), which improved to 31.7 (range 18-66) at 6 weeks and 31.1 (range 16-48) at 1 year. The improvements were statistically significant. Patients with involvement of C6 or C7 nerve roots responded slightly better at 6 weeks with regards to VAS improvement. Mean duration of radiation exposure during the procedure was 27.8 s (range 10-90 s). Only minor complications were noted-transient dizziness in two and transient nystagmus in one patient. Our 'two-needle technique' is a new, safe and effective non-surgical treatment for cervical radiculopathy.
authors.affiliation: New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK. naresh@doctors.org.uk
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Veda
authors.initials: V
authors.lastname: Gowda
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000294:innervation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D009407:Nerve Block / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D010147:Pain Measurement; D011843:Radiculopathy / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome