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A Cervical Nerve Block Approach to Improve Safety

Louis A. Gilula1 and Daniel Ma2

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
2 Department of Medicine, Tufts/New England Medical Center, Boston, MA.


Figure 1
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  		Fig. 1A —Radiographs show needle positions in cadaver. Lateral view shows that needle tip is displaced more than 3 needle-tip widths anterior to articular pillar.

 

Figure 2
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  		Fig. 1B —Radiographs show needle positions in cadaver. Oblique view shows that same anteriorly displaced needle appears adequately positioned as needle tip projects over anterior surface of articular pillar.

 

Figure 3
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  		Fig. 1C —Radiographs show needle positions in cadaver. Frontal view shows that same displaced needle tip appears adequately placed over midportion of articular pillar.

 

Figure 4
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  		Fig. 2A —Nerve block and focal foraminal epidural at left C5-C6 level in 33-year-old man undergoing selective cervical nerve block for right CT radiculopathy. Frontal view shows injectate with contrast flow, dispersion of contrast material, and no vascular filling.

 

Figure 5
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  		Fig. 2B —Nerve block and focal foraminal epidural at left C5-C6 level in 33-year-old man undergoing selective cervical nerve block for right CT radiculopathy. Oblique view shows contrast material outlining anterior margin of pillar and posterior surface of exiting nerve.

 

Figure 6
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  		Fig. 2C —Nerve block and focal foraminal epidural at left C5-C6 level in 33-year-old man undergoing selective cervical nerve block for right CT radiculopathy. Final frontal view shows 1.5 mL of injectate at end of injection. No contrast-filled vascular structures showed during or at end of injection. Injectate passed from C4 to C7 in epidural space.

 

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