Cervical Epidural Block Introduction

The use of epidural steroids in the cervical spine to treat chronic neck and upper extremity pain has been reported since 1984 (22). The translaminar route without fluoroscopic control has been utilized in most series (22-26). A criticism of this technique is the difficulty in assuming that the needle placement is in the epidural space as well as the risk of intradural puncture. More recently, the use of fluoroscopy and contrast media epidurography have been advocated by Johnson et al. to improve the safety and efficacy of the cervical epidural steroid injection (27). They performed 669 cervical epidural injections, mostly at C7-T1 over a 5.5-year-period in patients suffering neck pain with or without radiculopathy in a cohort study of 5334 patients receiving lumbar, cervical, and thoracic epidural steroid injections and reported only four complications in all the epidural injections. These consisted of transient hypotension; a small dorsal epidural hematoma, which resolved without intervention at 18-hours postinjection; and tachycardia and hypertension occurring 12 hours following a lumbar epidural injection. Only five patients were given intravenous (IV) conscious sedation due to severe anxiety before the procedure.

Direct cervical epidural needle puncture under fluoroscopy control with nonionic contrast epidurography for confirmation will allow a nonselective injection of steroid into the epidural space. The use of corticosteroid injection into the epidural space has been advocated to treat disc protrusion as well as chronic neck pain. Injectates typically ascend to the upper cervical spine and transverse the cervicothoracic region to T2 or lower (27).

Third Occipital Nerve Block FluoroscopyOccipital Nerve Block Fluoro
FIGURE 9 (A) Posteroanterior and (B and C) lateral projection. Third occipital nerve block; posterior approach. The needle target is the waist of the joint of C2, and once bone contact is made, the needle is advanced under lateral fluoro-scopic control to positions above and below the joint.

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Dealing With Back Pain

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