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

Park, Donghwi, MD

American Journal of Physical Medicine & Rehabilitation: April 2018 - Volume 97 - Issue 4 - p 242–247
doi: 10.1097/PHM.0000000000000825
Original Research Articles
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Objective The aim of the study was to evaluate the prevalence of vulnerable vessels around the target of cervical transforaminal epidural steroid injection at the C3-C7 cervical nerve root levels in a clinical setting.

Design Retrospective, cross-sectional study was conducted.

Participants Patients complaining of neck or arm pain with no previous surgical history and who had undergone both precontrast and contrast-enhanced neck computed tomography were included retrospectively.

Results In 26 (21.0%) of 124 patients, none of the vulnerable vessels around the target of cervical transforaminal epidural steroid injection around both sides of the C3-C7 nerve roots were observed. Of 248 cervical root levels, the C3 level had 103 vessels (41.5%), the C4 level had 110 vessels (44.4%), the C5 level had 98 vessels (39.5%), the C6 level had 59 vessels (23.8%), and the C7 level had 34 vessels (13.7%) close to each target nerve root. In addition, variations of the vertebral artery at the C4-C7 level were observed in 11 (8.9%) of 124 patients.

Conclusions To prevent unexpected critical complications involving injury to vulnerable vessels during cervical transforaminal epidural steroid injection, it is recommended to routinely evaluate the vulnerable vessels around the cervical nerve root with computed tomography or Doppler ultrasound before cervical transforaminal epidural steroid injection, especially for the upper cervical nerve root level.

From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea; and Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, South Korea.

All correspondence should be addressed to: Donghwi Park, MD, Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayangro 99, Dong gu, Daegu 41199, Republic of Korea.

This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2017R1D1A1B03033127).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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