Distribution Patterns of the Vulnerable Vessels Around Cervical Nerve Roots: A Computed Tomography-Based Study

Area of Science:

• Radiology
• Interventional Pain Management
• Anatomy

Background:

• Cervical transforaminal epidural steroid injections (CTFESI) are common for neck and arm pain.
• Potential vascular injury is a critical complication of CTFESI.
• Understanding the prevalence of vulnerable vessels is crucial for procedural safety.

Purpose of the Study:

• To determine the prevalence of vulnerable vessels adjacent to target cervical nerve roots (C3-C7) for CTFESI.
• To identify specific cervical levels with higher risk.

Main Methods:

• Retrospective, cross-sectional study.
• Analysis of precontrast and contrast-enhanced CT scans of 124 patients undergoing CTFESI.
• Evaluation of vascular structures around C3-C7 nerve roots.

Main Results:

• Vulnerable vessels were observed in 79% of patients (26% had none).
• Prevalence of vessels near target nerve roots: C3 (41.5%), C4 (44.4%), C5 (39.5%), C6 (23.8%), C7 (13.7%).
• Vertebral artery variations noted in 8.9% of patients at C4-C7.

Conclusions:

• Vulnerable vessels are frequently encountered around cervical nerve roots, especially at upper levels (C3-C5).
• Routine pre-procedural imaging (CT or Doppler ultrasound) is recommended to identify these vessels and mitigate risks.
• Enhanced vigilance is needed for upper cervical nerve root injections.