Fitzgerald Ryan T, Bartynski Walter S, Collins Heather R
Department of Radiology, Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital; Pittsburgh, PA, USA - Department of Radiology, Division of Neuroradiology, University of Arkansas for Medical Sciences, Department of Radiology; Little Rock, AK, USA -
Interv Neuroradiol. 2013 Dec;19(4):425-31. doi: 10.1177/159101991301900404. Epub 2013 Dec 18.
Cervical transforaminal epidural injections (C-TfEI) are commonly performed in patients with cervical radiculopathy/pain. C-TfEIs are typically performed without incident but adverse events can occur. Using CT-fluoroscopy-guided C-TfEI, we commonly observe the vertebral artery in proximity to the target injection site. The purpose of this study was to assess the position of the vertebral artery relative to the typical C-TfEI injection point. CT-fluoroscopy-guided C-TfEIs were performed at 70 levels in 68 patients with radiculopathy/neck pain (age range 19-83 yrs, mean 50.6 yrs). Degenerative neural foraminal narrowing at each level was characterized (normal-to-mild, moderate, severe). Vertebral artery position was categorized as: anterior (normal), partially covering neural foramen, complete/near-complete covering the neural foramen. Additional measured variables included angle of needle trajectory, foraminal angle, and whether or not needle trajectory intersected with the vertebral artery. Foraminal vertebral artery covering correlated with severity of foraminal degenerative narrowing (p=0.003). Complete/near-complete covering was seen in: 65% severely narrowed foramina, 30% moderately narrowed foramina and 10% normal/mildly-narrowed foramina. Needle trajectory intersected with the vertebral artery in 30 of 70 injections (46%) by CT-fluoroscopy, frequently associated with shallow (lateral) approaches. Foraminal angle, approximating oblique fluoroscopic technique, suggests needle trajectory intersection with the vertebral artery in 27 of 70 foramina (39%). Vertebral artery position is commonly displaced into the foramen in patients with advanced cervical degenerative disease. Operator awareness of altered vertebral artery position is important for determination of optimal needle trajectory and tip placement prior to injection in patients undergoing C-TfEI.
颈椎经椎间孔硬膜外注射（C-TfEI）常用于患有神经根型颈椎病/疼痛的患者。C-TfEI通常顺利进行，但也可能发生不良事件。使用CT透视引导下的C-TfEI，我们经常在目标注射部位附近观察到椎动脉。本研究的目的是评估椎动脉相对于典型C-TfEI注射点的位置。对68例患有神经根病/颈部疼痛的患者（年龄范围19 - 83岁，平均50.6岁）的70个节段进行了CT透视引导下的C-TfEI。对每个节段的退行性神经孔狭窄进行了特征描述（正常至轻度、中度、重度）。椎动脉位置分为：前方（正常）、部分覆盖神经孔、完全/近乎完全覆盖神经孔。其他测量变量包括针道角度、椎间孔角度以及针道是否与椎动脉相交。椎间孔椎动脉覆盖与椎间孔退行性狭窄的严重程度相关（p = 0.003）。在严重狭窄的椎间孔中，65%可见完全/近乎完全覆盖；中度狭窄的椎间孔中为30%；正常/轻度狭窄的椎间孔中为10%。在70次注射中有30次（46%）通过CT透视观察到针道与椎动脉相交，这通常与浅（外侧）进针途径有关。近似斜位透视技术的椎间孔角度提示在70个椎间孔中有27个（39%）针道与椎动脉相交。在晚期颈椎退行性疾病患者中，椎动脉位置通常会移位到椎间孔内。对于接受C-TfEI的患者，术者了解椎动脉位置的改变对于在注射前确定最佳针道和针尖位置很重要。
