Cervical transforaminal epidural steroid injections: a proposal for optimizing the preprocedural evaluation with...

Area of Science:

• Interventional Pain Management
• Neuroradiology
• Anatomical Risk Assessment

Background:

• Cervical transforaminal epidural steroid injection (CTFESI) is used for cervical radicular pain.
• Serious complications, including stroke, have been linked to CTFESI, often due to vertebral artery issues.
• Current safety recommendations often overlook detailed preprocedural anatomical risk assessment.

Purpose of the Study:

• To emphasize the importance of preprocedural anatomical evaluation for CTFESI safety.
• To highlight the risks associated with foraminal narrowing and vertebral artery proximity.
• To advocate for detailed MRI review to minimize procedural complications.

Main Methods:

• Review of potential complications associated with CTFESI.
• Analysis of anatomical correlations between foraminal narrowing and vertebral artery position.
• Proposal of preprocedural MRI review and simulation for risk assessment.

Main Results:

• Patients undergoing CTFESI often have foraminal narrowing, increasing risk.
• Standard C-arm angulation can inadvertently endanger the vertebral artery without anatomical knowledge.
• Preprocedural MRI review allows for identification of risks to vertebral and carotid arteries.

Conclusions:

• Preprocedural MRI review by interventionists is essential for optimizing CTFESI safety.
• Detailed anatomical assessment can guide needle trajectory to avoid vital structures.
• Risk mitigation strategies should prioritize patient-specific anatomical evaluation.