Ultrasound-Guided Selective Nerve Root Block for Surgical Planning in Multilevel Cervical Disc Disease: A Technical...

Area of Science:

• Neurosurgery
• Radiology
• Pain Management

Background:

• Selecting surgical levels for multilevel cervical disc disease is challenging using clinical exams and MRI alone.
• Fluoroscopy-guided selective nerve root blocks (SNRBs) carry risks of vascular injury due to potential intra-arterial injection.

Purpose of the Study:

• To describe the technical aspects of ultrasound-guided SNRB for preoperative surgical-level localization.
• To provide a reproducible protocol for clinical implementation of this technique.

Main Methods:

• Utilized a high-frequency linear transducer with Doppler for real-time visualization.
• Identified cervical levels based on transverse process morphology and located nerve roots using an in-plane approach.
• Administered sequential blocks with lidocaine, defining positive response as ≥50% arm pain reduction.

Main Results:

• Ultrasound guidance provided consistent visualization of nerve roots in all 30 patients (72 blocks).
• Power Doppler identified adjacent radicular arteries in 25% of cases, enabling trajectory adjustments to avoid vascular puncture.
• The sequential block protocol successfully identified symptomatic levels in all patients without complications.

Conclusions:

• Ultrasound-guided cervical SNRB is a safe, radiation-free alternative to fluoroscopy for preoperative level selection.
• The technique allows real-time visualization of nerve roots and vascular structures, enhancing safety.
• This detailed protocol facilitates clinical adoption for accurate surgical planning in cervical disc disease.