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A SUCCESFUL CASE OF CERVICAL SPONDYLOTIC RADICULOPATHY TREATED WITH ULTRASOUND-GUIDED ANTERIOR APPROACH TO CERVICAL NERVE ROOT BLOCK : A CASE REPORT
Author(s): ,
Fukazawa, K.*
Affiliations:
Kyoto Prefectural University of Medicine, Pain management & Palliative Care Medicine, kyoto, Japan
,
Hatano, K.
Affiliations:
Kyoto Prefectural University of Medicine, Pain management & Palliative Care Medicine, kyoto, Japan
,
Taniguchi, A.
Affiliations:
Kyoto Prefectural University of Medicine, Pain management & Palliative Care Medicine, kyoto, Japan
,
Gon, C.
Affiliations:
Kyoto Prefectural University of Medicine, Pain management & Palliative Care Medicine, kyoto, Japan
,
Hirose, M.
Affiliations:
Hyogo College of Medicine, Department of Anesthesiology and Pain Medicine, Hyogo, Japan
Hosokawa, T.
Affiliations:
Kyoto Prefectural University of Medicine, Pain management & Palliative Care Medicine, kyoto, Japan
ESRA Academy. Fukazawa K. Sep 13, 2017; 190871
Topic: Head and Neck Blocks
Dr. Keita Fukazawa
Dr. Keita Fukazawa

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Abstract
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Background and Aims:

Cervical nerve root block (CRB) is widely performed to treat radicular pain. Recent advancements in ultrasound devices have led to the popularization of ultrasound-guided CRB. With the fluoroscopic-guided method, the drug solution flows from the intervertebral foramen into the epidural space, whereas with the current ultrasound-guided CRB (US-CRB), the drug solution is administered further away from the intervertebral foramen peripherally. So we devised the ultrasound-guided anterior approach to CRB (US-ACRB) , where the needle is positioned centrally, enabling the central spread of the drug solution. Here, we report our experience treating a case that could be managed well using this technique. 

Methods:

The patient was a 53-year-old man with shooting pain in the right upper extremity. He was diagnosed with cervical spondylotic radiculopathy. Using the conventional method, US-CRB was performed, but very little improvement was observed.  

Results:

Then, right C6 CRB was performed using our new method, and the subject’s pain remarkably eased. With our method, the anterior tubercle was anteriorly delineated, and the articular pillars posteriorly . Between them, a long narrowly depicted nerve root was observed. The needle was inserted parallel in the anteromedial–posterolateral direction, passed posteriorly to the nerve root, and advanced up to the anterior surface of the articular pillars.

Conclusions:

We successfully suppressed shooting pain caused by cervical spondylotic radiculopathy, using a novel CRB, US-ACRB which allows for a central spread of the drug solution into the epidural space. We expect that US-ACRB has a lower risk of mispuncture of nerve  and vessels  compared with the fluoroscopic-guided method.

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