TRANSFORAMINAL CERVICAL NERVE ROOT BLOCK: OUTCOMES AND COMPLICATIONS

ABSTRACT Objectives: To investigate the effect and complications after transforaminal injection for cervicobrachialgia caused by cervical disc herniation. Methods: We retrospectively reviewed all patients undergoing fluoroscopy-guided transforaminal injection for radiculopathy caused by cervical disc herniation. During the last seven years, 57 patients (39 female, 18 male, mean age 45.6 years) experiencing cervical radiculopathy underwent cervical foraminal block guided by fluoroscopy by postero-lateral approach. The position of the needle was verified after injection of a small amount of contrast. A glucocorticosteroid was injected after 0.5 ml of 2% lidocaine. Results: The local with the highest prevalence of procedures was C6 root (31 procedures); 14 patients underwent C7 block, 7 had C5 block, and 5 in C4. Eight patients (14%) had complications (3 syncopes, 3 transient hoarseness, one patient had worsening of symptoms and one patient had soft tissue hematoma). In total, 42.1% were asymptomatic after the procedure and therefore did not require surgery after the procedure. Other 57.9% had transient improvement, became asymptomatic for at least 2 months but required surgery due to the recurrence of symptoms. Conclusion: Cervical foraminal block for cervical disc herniation is a safe way to avoid surgery. Some patients still need surgery after the procedure, but the temporary improvement in symptoms gives the patient some relief while awaiting surgery.

摘要
研究目的：探讨经椎间孔注射（transforaminal injection）治疗颈椎间盘突出症所致颈臂痛的临床疗效及并发症。
研究方法：本研究回顾性分析近7年内所有因颈椎间盘突出症引发神经根病、接受透视引导下经椎间孔注射治疗的患者。共纳入57例颈椎神经根病患者，其中女性39例，男性18例，平均年龄45.6岁。所有患者均采用后外侧入路，行透视引导下颈椎椎间孔阻滞：先注入少量造影剂确认针头位置，随后先注入0.5ml 2%利多卡因，再注入糖皮质激素（glucocorticosteroid）。
研究结果：本研究中操作最常累及的神经根为C6神经根（共31例次）；其次为C7神经根阻滞14例、C5神经根阻滞7例、C4神经根阻滞5例。共有8例患者（占比14%）出现术后并发症，包括3例晕厥、3例一过性声音嘶哑、1例症状加重及1例软组织血肿。术后42.1%的患者无相关症状，因此无需接受后续手术治疗；剩余57.9%的患者症状出现一过性改善，至少2个月无症状，但因症状复发仍需手术治疗。
研究结论：用于治疗颈椎间盘突出症的颈椎椎间孔阻滞是一种安全的可规避手术的治疗手段。尽管部分患者术后仍需接受手术，但症状的暂时性缓解可为等待手术的患者提供一定的症状缓解。