| 제목 |
USG Evaluation of Vulnerable Vessel around Cervical Nerve Root |
| 소속 |
Seoul National University Bundang Hospital, Department of Rehabilitation Medicine1, Daegu Fatima Hospital, Department of Rehabilitation Medicine2, Bundang CHA, Department of Rehabilitation Medicine3 |
| 저자 |
Hoon Hoon Lee, M.D1*, Donghwi Park, M.D.2, Yoongul Oh, M.D.3, Ju Seok Ryu, M.D., Ph.D.1† |
Objective
To evaluate the prevalence of vulnerable vessels around cervical nerve root before cervical nerve root block in the clinical setting.
Methods
This retrospective study included 74 patients with cervical radiculopathy who received ultrasonography guided nerve block at outpatient clinic from July 2012 to July 2014 at CHA Bundang Medical Center and July 2014 to December 2015 at Seoul National University Bundang Hospital. Before actual injection of steroid done, we evaluated the vulnerable vessels around each C5, C6, and C7 nerve root of patient’s painful side with Doppler ultrasound.
Results
Out of 74 cases, C5 level had 4 vessels (5.45%), C6 level 4 vessels (5.45%) and C7 level 6 vessels (8.11%) close to each target nerve root, and C5 level had 2 vessels (2.7%), C6 level 9 vessels (12.16%) and C7 level 10 vessels (13.51%) at the needle pathway to target nerve root, revealed by axial transverse ultrasound image with color Doppler. In total, C5 level had 6 vessels (8.11%), C6 level 13 vessels (14.86%) and C7 level 16 vessels (21.62%) at the target or at the needle pathway to target nerve root. There was unneglectable prevalence of vulnerable vessels at the target or the needle pathway. Also it shows higher prevalence of vulnerable vessels at target and needle pathway as the spinal nerve root levels gets lower.
Conclusion
To prevent unexpected critical complications involving vulnerable vessels injury during cervical nerve root block, it is recommended to routinely evaluate the vulnerable vessels around cervical nerve root with Doppler ultrasound before cervical nerve root block, especially for the lower cervical nerve root level.
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Figure 1. A. Axial transverse ultrasound image showing the C5 transverse process. Note the anterior tubercle (AT) and the posterior tubercle (PT) as the “2-humped camel” sign. Solid arrows indicates nerve root. B. Axial transverse ultrasound image with co
Figure 2. A. Axial transverse ultrasound image showing the C6 transverse process. Solid arrow indicates nerve root. B. Axial transverse ultrasound image with color Doppler revealing a vessel at the target nerve root (Solid arrow) in the intravertebral for
Figure 3. A. Other axial transverse ultrasound image showing the C5 transverse process. B. Axial transverse ultrasound image with color Doppler revealing a vessel in the needle pathway (dotted line) to target nerve root in the intraverterbral foramen. AT:
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