Korean J Anesthesiol.  2005 Oct;49(4):542-544. 10.4097/kjae.2005.49.4.542.

CT Guided Cervical Transforaminal Steroid Injection for the Elderly Patient with Enlarged Internal Jugular Vein and Vertebral Artery: A case report

• Kim H
• Lee SH
• Han YM
• Lee EW

• KMID: 1936859
• DOI: http://doi.org/10.4097/kjae.2005.49.4.542

Abstract

Seventy nine-year old female patient visited our department presenting radicular pain on her neck, left shoulder and arm. She had a history of hypertension and underwent coronary angiography and angioplasty 4 years ago. Cervical MRI showed central disc herniation with osteophyte and left foraminal stenosis at C5-6 level and bulging disc with osteophyte and foraminal stenosis (left > right) at C6-7. First plan was transforaminal steroid injection under C-arm fluoroscopy at C5-6 level. Unexpectedly, we could find enlarged internal jugular vein and vertebral artery on MRI scan, which is due to cardiovascular disease. These important vascular structures were expected to be injured by needle during the procedure if done under C-arm fluoroscopy. We decided to give transforaminal steroid injection under CT fluoroscopy to avoid injury to the large vessels and inadvertent complication. The procedure was successfully done using CT fluoroscopy (Brilliance 10(TM), Philips(R), USA) without any complication associated with vascular injury or intravascular injection.

Keyword

computed tomography; spinal stenosis; transforaminal steroid injection

MeSH Terms

Aged*
Angioplasty
Arm
Cardiovascular Diseases
Constriction, Pathologic
Coronary Angiography
Female
Fluoroscopy
Humans
Hypertension
Jugular Veins*
Magnetic Resonance Imaging
Neck
Needles
Osteophyte
Shoulder
Spinal Stenosis
Vascular System Injuries
Vertebral Artery*