title: CT-guided cervical selective nerve root block with a dorsal approach.
abstract: OBJECTIVE
  Cervical transforaminal blocks are frequently performed to treat cervical radicular pain. These blocks are performed mostly under fluoroscopy, but a CT-guided technique has also been described. The aim of this study was to review the results of CT-guided CSNRB by using a dorsal approach, to describe the contrast patterns achieved with this injection technique, and to estimate the degree of specificity and sensitivity.
  
  
  METHODS
  We used a CT-guided technique with a dorsal approach leading to a more extra-than transforaminal but a selective nerve root block as well. Of 53 blocks, we performed 38 for diagnostic and 15 for therapeutic indications. Pain relief was measured hourly on a VAS. The distribution of contrast and the angle of the trajectory of the injection needle were analyzed as well as the degree of pain relief.
  
  
  RESULTS
  Contrast was found in the intraforaminal region in 8 (15%) blocks, extraforaminally in 40 (78%) blocks, and intraspinally in 3 (6%) blocks. The mean angle between the needle and the sagittal plane was 26.6° (range, from 1° to 50°). The mean distance between needle tip and nerve root was 4.43 mm (range, 0-20 mm). Twenty-six (68.4%) of the 38 diagnostic blocks led to a decrease in the pain rating of >50%. There were no complications or unintended side effects, apart from occasional local puncture pain.
  
  
  CONCLUSIONS
  We conclude that CT-guided CSNRBs using a dorsal approach are feasible and that they are sensitive and specific.
authors.affiliation: Interdisciplinary Pain Centre, University Hospital Freiburg, Germany. tilman.wolter@uniklinik-freiburg.de
authors.forename: T
authors.initials: T
authors.lastname: Wolter
authors.forename: S
authors.initials: S
authors.lastname: Knoeller
authors.forename: A
authors.initials: A
authors.lastname: Berlis
authors.forename: C
authors.initials: C
authors.lastname: Hader
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D006801:Humans; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D009339:Needles; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
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