Preoperative precise location of responsible segment of cervical radiculopathy: the development of selective nerve root block / 中华骨科杂志

ABSTRACT

Cervical spondylotic radiculopathy is one of the commonly seen spinal surgery diseases. For well?diagnosed and well?located cervical spondylotic radiculopathy, surgical intervention can effectively alleviate symptoms. With the wide appli?cation of minimally invasive surgical techniques, the requirements for precise preoperative orientation of responsible segments have increased, especially in multisegmental cervical spondylotic radiculopathy cases. However, due to the cutaneous pain distri?bution is often atypical, magnetic resonance imaging and neurological examinations may be not reliable enough for accurate loca?tion preoperatively which may fail to get a satisfactory surgical outcome. Selective nerve root block (SNRB) in preoperative localiza?tion of responsible nerve roots in cervical spondylotic radiculopathy has gradually increased. Yet this technology has been mostly used by anesthesiologists or radiologists, this field in minimally invasive spinal surgery is relatively blank. As we know, there is no previous review summarized the commonly used approaches of SNRB, the risk factors relating to complications, and the local pre?cise blood vessels anatomy. In summary, we believe that combination these series of points with the necessity of preoperative pre?cise location in cervical spondylotic radiculopathy may increase the safety of cervical SNRB. The keywords about "cervical" and"selective nerve root block" have been used in English and Chinese literature databases. The articles were filtrated by title, ab?stract and full text. There were 21 articles taken in the review. We summarized the history and distinction of different approaches including anterior lateral approach, lateral approach, posterior lateral approach, dorsal "direct" approach and dorsal'indirect'ap?proach, and described the indication of each approach. As well as the factors associating with catastrophic complications in cervi?cal SNRB, for instance, the vascular distribution relating to vascular mistaken injection, steroid kind selection because large ste?roid particle may block some thin but vital arteries. In addition to cervical local blood vessels distribution and variation, the needle trajectory also played a key role in the complications of SNRB. Besides, other controversy points, such as whether use contrast me?dia or not, the importance of the lateral position of the cervical spine, etc., were discussed in this review based on clinical research?es. The purpose of the present study is hoping to provide some references for spine surgeons to apply SNRB technology more safely.