Image Guided Cervical Nerve Root Sleeve Corticosteroid Injection
What are the generally accepted indications for a cervical nerve root sleeve injection? Cervical radiculopathy from disc protrusion or degenerative…Read more
Clinical evidence of radiculopathy without acute muscle weakness as a result of degenerative changes and not malignancy or infection.
CT or magnetic resonance imaging will have been carried out before this procedure is considered, and will often show degenerative changes and/or disc compression of the neural foramen. Discussion with the patient about other conservative (e.g. anti-inflammatory medications, physiotherapy) and surgical options for management of the pain is recommended.
A general anaesthetic is not appropriate, as patient input is required for safety of the procedure. However, the procedure may at times be carried out with sedation in patients with an intellectual disability or dementia. An interpreter may be required with language difficulties.
Antiplatelet agents and other anticoagulants may need dose adjustment or cessation. Generally, an INR of 1.5 or less and cessation of antiplatelet agents for 10 days before the procedure is recommended, although aspirin is usually allowed to continue. It is recognised that this may pose a significant risk to some patients; for example, those with atrial fibrillation or recent coronary stents. Therefore, there needs to be discussion with the radiologist in this situation about the relative risks of ceasing medication versus the haemorrhagic complications of the procedure.
Most patients are able to continue normal activities the next day.
In the event further complications develop, immediate review is advised.
Surgical decompression of the foramen.
Accurate localisation with imaging confirmation of the pathology is essential. This is a very useful procedure for the right patient, as it may delay or avoid the need for surgery, but has potential catastrophic complications.
Page last modified on 26/7/2017.
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