title: Combined fluoroscopic and ultrasound guided cervical nerve root injections.
abstract: To assess the technical feasibility, safety and initial clinical efficacy of a combined ultrasound and fluoroscopy imaging approach to cervical nerve root blocks. Fluoroscopic guided cervical transforaminal and selective nerve root injections are often used in the investigation or treatment of radicular symptoms, although rare but serious complications including death have been reported. We report a combined technique developed to increase safety of selective nerve root injections, including the safety and early efficacy of this novel technique in our initial patient cohort.
  
  
  
  We retrospectively reviewed a consecutive cohort of injections performed in 149 patients by a single consultant radiologist between December 2010 and August 2012. For all patients the outcome was assessed both immediately following the procedure and at six weeks. Primary outcome was reduction in radicular symptom level. Duration of symptoms were also assessed and all complications were recorded.
  
  
  
  One hundred and forty nine patients underwent injection at either one or two cervical levels. No patients experienced any complications during the follow-up period, and 72 % had an initial positive response to the injection. Of these, 42 % were discharged to the care of their General Practitioner, 23 % went on to have surgery, 18 % were actively monitored in a specialist clinic, 10 % were referred to our pain management service and 4 % had the injection repeated after symptoms recurred.
  
  
  
  Using this combined image guided technique cervical nerve root blocks appear both safe and effective in the investigation and management of radicular symptoms from the cervical spine.
authors.affiliation: Frimley Park Hospital, Frimley, GU16 7UJ, UK. cpwakeling@mac.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wakeling
authors.affiliation: Frimley Park Hospital, Frimley, GU16 7UJ, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Bateman
authors.affiliation: Frimley Park Hospital, Frimley, GU16 7UJ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hatrick
authors.affiliation: Frimley Park Hospital, Frimley, GU16 7UJ, UK.
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Chatakondu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066193:Cervical Cord; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011843:Radiculopathy / Q000188:drug therapy*; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000187:drug effects*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Cervical spine; Fluoroscopy; Injection; Nerve root block; Ultrasound