title: Ultrasonography Evaluation of Vulnerable Vessels Around Cervical Nerve Roots During Selective Cervical Nerve Root Block.
abstract: OBJECTIVE
  To evaluate the prevalence of vulnerable blood vessels around cervical nerve roots before cervical nerve root block in the clinical setting.
  
  
  METHODS
  This retrospective study included 74 patients with cervical radiculopathy who received an ultrasonography-guided nerve block at an outpatient clinic from July 2012 to July 2014. Before actual injection of the steroid was performed, we evaluated the vulnerable blood vessels around each C5, C6, and C7 nerve root of each patient's painful side, with Doppler ultrasound.
  
  
  RESULTS
  Out of 74 cases, the C5 level had 2 blood vessels (2.7%), the C6 level had 4 blood vessels (5.45%), and the C7 level had 6 blood vessels (8.11%) close to each targeted nerve root. Moreover, the C5 level had 2 blood vessels (2.7%), the C6 level 5 blood vessels (6.75%), and the C7 level had 4 blood vessels (5.45%) at the site of an imaginary needle's projected pathway to the targeted nerve root, as revealed by axial transverse ultrasound imaging with color Doppler imaging. In total, the C5 level had 4 blood vessels (5.45%), the C6 level 9 blood vessels (12.16%), and the C7 level 10 had blood vessels (13.51%) either at the targeted nerve root or at the site of the imaginary needle's projected pathway to the targeted nerve root. There was an unneglectable prevalence of vulnerable blood vessels either at the targeted nerve root or at the site of the needle' projected pathway to the nerve root. Also, it shows a higher prevalence of vulnerable blood vessels either at the targeted nerve root or at the site of an imaginary needle's projected pathway to the nerve root as the spinal nerve root level gets lower.
  
  
  CONCLUSIONS
  To prevent unexpected critical complications involving vulnerable blood vessel injury during cervical nerve root block, it is recommended to routinely evaluate for the presence of vulnerable blood vessels around each cervical nerve root using Doppler ultrasound imaging before the cervical nerve root block, especially for the lower cervical nerve root level.
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Hoon Hoon
authors.identifier: 0000-0002-5028-4318
authors.initials: HH
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Donghwi
authors.identifier: 0000-0002-7724-4682
authors.initials: D
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Yoongul
authors.identifier: 0000-0003-4324-9765
authors.initials: Y
authors.lastname: Oh
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Ju Seok
authors.identifier: 0000-0003-3299-3038
authors.initials: JS
authors.lastname: Ryu
keywords: Blood vessels; Epidural injections; Intervertebral disc displacement; Ultrasonography