Selective cervical nerve root blockade: prospective study of immediate and longer term complications.

BACKGROUND AND PURPOSE: Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB. MATERIALS AND METHODS: Eight hundred two consecutive fluoroscopically guided diagnostic and/or therapeutic SCNRBs in 659 patients were performed during a 14-month period (November 2006-December 2007) at affiliated outpatient imaging centers. Each examination was performed by 1 of 8 experienced procedural radiologists by using an anterior oblique approach, with the needle position confirmed with radiographic contrast before injection of an admixture of local anesthetic and steroid. All patients were assessed immediately and at 30 minutes following the procedure. Additionally, 460 patients were called by telephone 30 days following the procedure. All complications were recorded. RESULTS: Of the 802 attempted procedures, 799 were successfully completed. Three procedures were aborted due to anxiety, challenging body habitus, or persistent venous opacification observed during contrast injection and despite needle repositioning. There were no serious complications, such as stroke, spinal cord insult, permanent nerve root deficit, infection, or significant hematoma. There were 33 minor complications occurring within 30 minutes of the procedure; the most common was vasovagal symptoms. Three hundred forty-five patients were successfully contacted by telephone at 30 days postinjection, 9 of whom reported increased or new pain symptoms. CONCLUSIONS: With our technique, fluoroscopically guided SCNRB is a safe outpatient procedure with a low immediate and delayed complication rate.

Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement.

BACKGROUND AND PURPOSE: [corrected] Our aim was to evaluate the safety and clinical utility of a fluoroscopically guided anterolateral oblique approach technique for outpatient diagnostic and therapeutic selective cervical nerve root blockade (SCNRB). MATERIALS AND METHODS: During a 13-year period (1994 through February 2007), 4612 patients underwent fluoroscopically guided diagnostic and/or therapeutic extraforaminal SCNRB by using an anterior oblique approach at affiliated outpatient imaging centers. Each procedure was performed by 1 of 6 procedural radiologists, all highly experienced in and actively performing spinal injections on a full-time basis in clinical practice. All of the proceduralists were thoroughly experienced with lumbar injections before endeavoring to perform SCNRBs. Nonionic contrast was injected in nearly all patients (except isolated patients with contrast allergy), and a minimum of 2 projection filming procedures were performed to document the accuracy of needle placement and contrast dispersal before the injection of therapeutic substances. All clinically significant complications beyond skin discoloration and temporary exacerbation of symptoms were recorded. RESULTS: There were no serious neurologic complications, such as stroke, spinal cord insult, or permanent nerve root deficit. One life-threatening anaphylactic reaction occurred and was attributed to the injected materials and not the specific procedure itself. Another patient had a 3- to 4-minute grand mal seizure, from which he fully recovered within 30 minutes. There were no infections. CONCLUSION: The technique we describe for fluoroscopically guided SCNRB is a useful and safe outpatient procedure when performed by skilled and experienced proceduralists.

Diskography: infectious complications from a series of 12,634 cases.

BACKGROUND AND PURPOSE: Diskography is commonly performed to investigate pain of suspected diskogenic origin. Although uncommon, diskitis is a feared complication of this procedure. We reviewed the incidence of diskitis and other infectious complications following diskography in a large busy outpatient practice and discuss technical aspects that may contribute to infection prevention. METHODS: We reviewed the electronic records of all diskograms obtained at our institution during a 12.25-year period, looking for all cases of procedure-related infection. All diskograms had been obtained by skilled and experienced procedural radiologists in dedicated spine-injection suites with specialized technical staff. RESULTS: There were 12,634 examinations performed on 10,663 patients for a total of 37,135 disk levels. Of the disk levels, 5981 were cervical; 3083, thoracic; and 28,071, lumbar. Two cases of confirmed lumbar diskitis and no cases of either cervical or thoracic diskitis were seen in our series. No other infectious complications were found. The incidence of diskitis was 0.016% per examination and 0.0054% per disk level. CONCLUSION: In skilled and experienced hands using proper technique, diskography is a safe outpatient procedure with an extremely low incidence of diskitis and other procedure-related infections.

Nasojejunal feeding tube placement in children: four-year cumulative experience.

PURPOSE: Experience with fluoroscopically guided nasojejunal feeding tube placement in children was assessed regarding clinical diagnosis, fluoroscopy time, radiation dose, success rate, and placement failures. MATERIALS AND METHODS: From 1987 to 1991, 562 nasojejunal tubes were placed in 232 patients aged 1 week to 24 years (mean, 3 1/2 years) at the authors' institution. In every case, an 8-F feeding tube system was inserted. The fluoroscopy times and tube placement positions were evaluated in all cases. RESULTS: The mean fluoroscopy time was 5 minutes 30 seconds, which corresponded to an estimated mean midline fluoroscopy dose of 0.32 cGy. The tube was placed at or distal to the duodenojejunal junction in 543 attempts, for a success rate of 97%. The most common cause for unsuccessful tube placement was malrotation, with the fluoroscopic time and radiation dose significantly (P < .001) prolonged in these cases. CONCLUSION: Fluoroscopic guidance of placement of nasojejunal feeding tubes in children is successful, but the radiation exposure is not negligible and must be weighed against the need for nasojejunal feeding.

Imaging the testis: comparison between MR imaging and US.

The potential role of magnetic resonance (MR) imaging in the diagnosis and local staging of testicular tumors was evaluated in 23 patients who subsequently underwent surgery or biopsy. Findings at MR imaging were compared with those at ultrasonography (US) and were correlated with the surgical-histologic findings. At surgery, three patients were found to have extratesticular and 20 patients intratesticular abnormalities. This distinction had been correctly made with both imaging modalities, but US did not demonstrate the intratesticular abnormality in four patients with diffuse infiltrating tumors. Neither modality allowed differentiation of benign from malignant disorders. When local tumor staging was analyzed in 11 patients, the accuracy of both modalities was disappointing (true-positive findings with MR imaging in seven patients and with US in five). At present, US remains the primary imaging modality for testicular disease. MR imaging should be employed when findings at physical examination and US are discrepant and considered when diffuse infiltrative disease is suspected.