Chapter 16

### INTRODUCTION

The use of cervical root blocks can be used both diagnostically and/or therapeutically. In certain conditions, a nerve root block can help determine whether the nerve root in question is either contributing or the cause of the pain. Because the technique lends itself to both diagnostic and therapeutic uses, cervical nerve root blocks are an essential part of an interventional practice. Each of the levels, other than C1 and C2, can be accessed for a selective injection. A selective nerve root block is intended to determine whether the suspected nerve root is involved in the pathology and pain from the nerve root compression or irritation.

Cervical radiculitis affects approximately 83 per 100,000 people per year.1 The most common causes of cervical radiculitis in this study were herniated disk in 21.9% and spondylosis in 68.4%. Anderberg and colleagues2 described the method of a cervical diagnostic SNRB technique and assessed its ability to correlate clinical symptoms with MRI findings in patients with cervical radicular pain and a single level degenerative disease.

• The majority of those affected did not undergo surgery.

• Outcomes were favorable in both surgically and nonsurgically treated groups without reproducible significant outcome differences of one treatment over the other.1, 2, and 3

• The favorable outcome from cervical radiculitis from herniated disk may be due in part to the natural regression of disk herniation over time.4,5

• However, well-designed randomized trials of surgical and nonsurgical outcomes for specific diagnostic entities have not been performed.

• Current treatment strategies typically involve a gradual progression in the aggressiveness of intervention, progressing from less to more invasive interventions only in refractory cases.

### ANATOMY

The cervical spine consists of seven vertebrae, eight nerves, and two vertebral arteries that supply the posterior aspect of the brain contributing to the circle of Willis (Figure 16-1).

###### Figure 16-1.

Cervical spine anatomy.

Understanding cervical spine anatomy is imperative to the interventionalist performing cervical spine procedures.

• The epidural space is triangular extending from the foramen magnum to the sacral hiatus. The inner border is the thecal sac-dura mater.

• The outer border is the bony spinal canal and the covering periosteum.

• The anterior border is the posterior longitudinal ligament. The posterior border is the lamina and ligamentum flavum.

• The lateral border is the pedicle and intervertebral foramen.

• The epidural space contains loose areolar tissue, venous plexus, spinal nerve roots, radicular arteries, superficial and deep cervical arteries, arachnoid granules, and lymphatics.

• The ligamentum flavum is fused in the midline in approximately half of individuals and the interspinous ligament is absent.

• Rootlets arise from the cord to form ventral and dorsal nerve roots that exit with the thecal sac covered with the dura root sleeve.

• The dura ends at the proximal margin ...

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