Must we discontinue selective cervical nerve root blocks? Report of two cases and review of the literature

Abstract

We report two detrimental neurologic complications after technically correct selected cervical nerve root blocks. Based on these cases and a thorough review of the literature, the indication for cervical nerve root blocks was reconsidered and limited. Similarly, we modified our technique to further reduce the likelihood for the occurrence of such severe complications.

Fig. 1

Imaging studies of a 71 year old female (Case 1). a C7/T1 foraminal injection on the left side. Needle position outside the intervertebral foramen. A tentative injection of contrast media demonstrated extraforaminal contrast distribution. b T2-weighted sagittal MR image obtained 1 day after injection demonstrating ischemic myelopathy at the C5–C7 levels

Fig. 2

Imaging studies of a 59 year old male (Case 2). a Needle tip at the entrance of the right C6/7 foramen dorsally, after injection of 0.5 ml of contrast agent. b Sagittal T2-weighted MR image obtained 1 day after injection demonstrated spinal cord signal abnormalities consistent with ischemic myelopathy at the levels C4–C6

Fig. 3

The patient is positioned supine and the needle is advance to the lateral and anterior aspect of the facet joint