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A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections
Kenneth D Candido1, Ramsis F Ghaly, Sara Mackerley
1Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA. kdcandido@yahoo.com
A case report highlights that even with specialized needles and fluoroscopic guidance, vascular injection can occur during cervical selective nerve root blocks. Needle aspiration is not a reliable indicator of intravascular injection.
Area of Science:
- Pain Medicine
- Interventional Radiology
- Neurosurgery
Background:
- Cervical selective nerve root injections are common procedures for diagnosing and treating neck pain.
- Minimizing risks like intravascular injection is crucial for patient safety.
Observation:
- A 41-year-old female underwent a cervical selective nerve root injection.
- A 22-gauge Whitacre-type spinal needle with a distal curve was used under continuous fluoroscopic guidance.
- Despite negative aspiration for blood and CSF, and no paresthesias, contrast injection revealed vascular runoff.
Findings:
- The case demonstrates that Whitacre-type spinal needles do not inherently prevent intravascular injection.
- Aspiration of the needle prior to injection is not a foolproof method to detect intravascular placement.
Implications:
- This finding necessitates a re-evaluation of safety protocols for cervical nerve root injections.
- Enhanced vigilance and potentially alternative safety measures are required to prevent vascular complications.
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