Cervical transforaminal epidural steroid injection (CT-guided)

Case contributed by Dr Dai Roberts

Presentation

Left arm radicular pain. Injection for diagnostic and therapeutic reasons.

Patient Data

Age: 60 years
Gender: Female

CT guided transforaminal epidural steroid injection (TFESI) targeting the left C6/7 foramina and exiting left C7 nerve root.

The tip of 25G needle is on the ventral aspect of left C7 transverse process.  The injected iodinated contrast surrounds the left C7 nerve root with epidural extension. 

Case Discussion

Spinal and associated nerve root intervention can be performed with CT and fluoroscopy.  In the correct hands, both can be used for cervical TFESI but extreme care must be taken due to the close relationship of the vertebral artery, foramina and exiting nerve root. 

Smaller gauge 25G needles are preferred to the 22G needles used in the lumbosacral spine.  The use of iodinated contrast allows correct identification of needle position and confirm the injectate will pass into the desired epidural space. 

Non-particulate steroids, such as dexamethasone, are preferred due to the risk of inadvertent vascular injection. 

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Case information

rID: 75198
Published: 20th Mar 2020
Last edited: 23rd Apr 2020
Inclusion in quiz mode: Included
Institution: St. Paul's Hospital

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