Background: A number of serious complications associated with
fluoroscopically guided extraforaminal cervical nerve blocks have been
reported in the literature. The purpose of the present study was to determine
the rate of complications associated with these blocks and to determine
whether needle positioning during the procedure affected the prevalence of
complications at one institution.
Methods: Between October 1999 and June 2003, we performed 1036
fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients.
Plain radiographs documenting the procedure were made as part of the standard
quality-assurance protocol. An independent observer who was uninvolved with
the procedures reviewed a prospectively kept database on all patients. We
subsequently reviewed the patient records to identify complications.
Results: There were no catastrophic complications such as vessel
damage, paralysis, or death. Overall, fourteen patients (1.66%) had a minor
complication in association with the procedure. With the numbers available,
the rate of complications associated with pdeep injection (798 blocks) was not
significantly different from that associated with shallow injection (238
blocks) (1.89% compared with 0.84%). However, the rate of complications
associated with anterior placement of the needle tip (thirty-three blocks) was
higher than that associated with ideal placement of the needle tip (904
blocks) (6.06% compared with 1.55%) (p = 0.04).
Conclusions: No catastrophic complications occurred in this series
of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on
frontal-view radiographs was not associated with complications, although the
anterior positioning of the needle as seen on lateral-view radiographs was
associated with minor complications. Our results suggest that, with our
technique, cervical nerve blocks are relatively safe procedures.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.