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<meta name="DC.Title" content="CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3266" />
<meta name="DC.Date" content="2013-03-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate.

MATERIALS AND METHODS: We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution.

RESULTS: The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) ( P value &lt;.0001). There was no relationship between needle angle and contrast distribution.

CONCLUSIONS: Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

CTSI
:   cervical transforaminal steroid injections" />
<meta name="DC.Contributor" content="J.K. Hoang" />
<meta name="DC.Contributor" content="D.P. Massoglia" />
<meta name="DC.Contributor" content="M.A. Apostol" />
<meta name="DC.Contributor" content="C.D. Lascola" />
<meta name="DC.Contributor" content="J.D. Eastwood" />
<meta name="DC.Contributor" content="P.G. Kranz" />
<meta name="article:published_time" content="2013-03-01" />
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<meta name="citation_title" content="CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (&lt;i&gt;P&lt;/i&gt; value &amp;lt;.0001). There was no relationship between needle angle and contrast distribution.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.&lt;/p&gt;" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate.

MATERIALS AND METHODS: We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution.

RESULTS: The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) ( P value &lt;.0001). There was no relationship between needle angle and contrast distribution.

CONCLUSIONS: Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

CTSI
:   cervical transforaminal steroid injections" />
<meta name="og-title" property="og:title" content="CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?" />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate.

MATERIALS AND METHODS: We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution.

RESULTS: The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) ( P value &lt;.0001). There was no relationship between needle angle and contrast distribution.

CONCLUSIONS: Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

CTSI
:   cervical transforaminal steroid injections" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node12292--5" data-node-nid="12292" id="top-node-12292--6853850913" data-pisa="ajnr;34/3/688" data-pisa-master="ajnr;ajnr.A3266" data-apath="/ajnr/34/3/688.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Spine</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A3266" data-atom-uri="/ajnr/34/3/688.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.K. Hoang</span>, <span class="highwire-citation-author" data-delta="1">D.P. Massoglia</span>, <span class="highwire-citation-author" data-delta="2">M.A. Apostol</span>, <span class="highwire-citation-author" data-delta="3">C.D. Lascola</span>, <span class="highwire-citation-author" data-delta="4">J.D. Eastwood</span> and <span class="highwire-citation-author" data-delta="5">P.G. Kranz</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">688-692; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3266 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12292--6853850913" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.K. Hoang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.K.H., C.D.L., J.D.E., P.G.K.), Division of Neuroradiology</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiation Oncology (J.K.H.), Duke University Medical Center, Durham North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.K.%2BHoang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hoang%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.K.%2BHoang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D.P. Massoglia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (D.P.M.), Ralph Johnson VA Medical Center, Charleston, South Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.P.%2BMassoglia%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Massoglia%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.P.%2BMassoglia%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.A. Apostol </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Clinical Radiologists S.C. (M.A.A.), Springfield, Illinois.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.A.%2BApostol%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Apostol%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.A.%2BApostol%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C.D. Lascola </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.K.H., C.D.L., J.D.E., P.G.K.), Division of Neuroradiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.D.%2BLascola%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lascola%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.D.%2BLascola%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.D. Eastwood </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.K.H., C.D.L., J.D.E., P.G.K.), Division of Neuroradiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.D.%2BEastwood%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Eastwood%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.D.%2BEastwood%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">P.G. Kranz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.K.H., C.D.L., J.D.E., P.G.K.), Division of Neuroradiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.G.%2BKranz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kranz%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.G.%2BKranz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.1" data-doi="10.1093/brain/117.2.325"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Radhakrishnan</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Litchy</span>  <span class="cit-name-given-names">WJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">O'Fallon</span>  <span class="cit-name-given-names">WM</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990</span>. <abbr class="cit-jnl-abbrev">Brain</abbr> <span class="cit-pub-date">1994</span>;<span class="cit-vol">117</span>(<span class="cit-issue">pt 2</span>):<span class="cit-fpage">325</span>–<span class="cit-lpage">35</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiYnJhaW4iO3M6NToicmVzaWQiO3M6OToiMTE3LzIvMzI1IjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzM0LzMvNjg4LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.2" data-doi="10.1007/s00701-005-0542-2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kolstad</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Leivseth</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nygaard</span>  <span class="cit-name-given-names">OP</span></span></li></ol><cite>. <span class="cit-article-title">Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study</span>. <abbr class="cit-jnl-abbrev">Acta Neurochir (Wien)</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">147</span>:<span class="cit-fpage">1065</span>–<span class="cit-lpage">70</span>, <span class="cit-comment">discussion 1070</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00701-005-0542-2&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15924210&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F688.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.3" data-doi="10.2214/AJR.10.4369"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Hoang</span>  <span class="cit-name-given-names">JK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Apostol</span>  <span class="cit-name-given-names">MA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kranz</span>  <span class="cit-name-given-names">PG</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material</span>. <abbr class="cit-jnl-abbrev">AJR Am J Roentgenol</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">195</span>:<span class="cit-fpage">888</span>–<span class="cit-lpage">94</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.2214/AJR.10.4369&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=20858814&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F688.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.4"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cho</span>  <span class="cit-name-given-names">CH</span></span></li></ol><cite>. <span class="cit-article-title">Cervical nerve injection: computed tomography guidance with intravenous contrast and extraforaminal needle placement. Series of seven consecutive case reports</span>. <abbr class="cit-jnl-abbrev">Spine J</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">10</span>:<span class="cit-fpage">e1</span>–<span class="cit-lpage">6</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=20189462&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F688.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a>

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<div class="cit ref-cit ref-journal" id="cit-34.3.688.6"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Wagner</span>  <span class="cit-name-given-names">AL</span></span></li></ol><cite>. <span class="cit-article-title">CT fluoroscopic-guided cervical nerve root blocks</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">43</span>–<span class="cit-lpage">44</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo3OiIyNi8xLzQzIjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzM0LzMvNjg4LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">7.</span><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7. in text" id="ref-7">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.7"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cyteval</span>  <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Thomas</span>  <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Decoux</span>  <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Cervical radiculopathy: open study on percutaneous periradicular foraminal steroid infiltration performed under CT control in 30 patients</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">25</span>:<span class="cit-fpage">441</span>–<span class="cit-lpage">45</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyNS8zLzQ0MSI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zNC8zLzY4OC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">8.</span><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8. in text" id="ref-8">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.8" data-doi="10.1097/BRS.0b013e318194e247"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Malhotra</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Abbasi</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rhee</span>  <span class="cit-name-given-names">M</span></span></li></ol><cite>. <span class="cit-article-title">Complications of transforaminal cervical epidural steroid injections</span>. <abbr class="cit-jnl-abbrev">Spine (Phila Pa 1976)</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">731</span>–<span class="cit-lpage">39</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1097/BRS.0b013e318194e247&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.9" data-doi="10.1053/j.trap.2009.07.004"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kushnerik</span>  <span class="cit-name-given-names">V</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Altman</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gozenput</span>  <span class="cit-name-given-names">P</span></span></li></ol><cite>. <span class="cit-article-title">Pharmacology of steroids used during epidural steroid injections</span>. <abbr class="cit-jnl-abbrev">Techniques in Regional Anesthesia and Pain Management</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">13</span>:<span class="cit-fpage">212</span>–<span class="cit-lpage">16</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1053/j.trap.2009.07.004&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.10" data-doi="10.1097/00002060-200212000-00003"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Botwin</span>  <span class="cit-name-given-names">KP</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gruber</span>  <span class="cit-name-given-names">RD</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bouchlas</span>  <span class="cit-name-given-names">CG</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study</span>. <abbr class="cit-jnl-abbrev">Am J Phys Med Rehabil</abbr> <span class="cit-pub-date">2002</span>;<span class="cit-vol">81</span>:<span class="cit-fpage">898</span>–<span class="cit-lpage">905</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1097/00002060-200212000-00003&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12447088&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F688.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000179324600003&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><span class="ref-label">11.</span><a class="rev-xref-ref" href="#xref-ref-11-1" title="View reference 11. in text" id="ref-11">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.11" data-doi="10.1007/s00586-005-0024-5"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Anderberg</span>  <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Saveland</span>  <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Annertz</span>  <span class="cit-name-given-names">M</span></span></li></ol><cite>. <span class="cit-article-title">Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography</span>. <abbr class="cit-jnl-abbrev">Eur Spine J</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">15</span>:<span class="cit-fpage">1465</span>–<span class="cit-lpage">71</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00586-005-0024-5&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16341556&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F3%2F688.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000241355200005&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><span class="ref-label">12.</span><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12. in text" id="ref-12">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.3.688.12" data-doi="10.1097/00007632-200301010-00007"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Furman</span>  <span class="cit-name-given-names">MB</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Giovanniello</span>  <span class="cit-name-given-names">MT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">O'Brien</span>  <span class="cit-name-given-names">EM</span></span></li></ol><cite>. <span class="cit-article-title">Incidence of intravascular penetration in transforaminal cervical epidural steroid injections</span>. <abbr class="cit-jnl-abbrev">Spine (Phila Pa 1976)</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">21</span>–<span class="cit-lpage">25</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1097/00007632-200301010-00007&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li></ol></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 34</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2013 </div></div>
      
      
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      <div class="highwire-cite-title">CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.K.</span> <span class="nlm-surname">Hoang</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.P.</span> <span class="nlm-surname">Massoglia</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.A.</span> <span class="nlm-surname">Apostol</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.D.</span> <span class="nlm-surname">Lascola</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.D.</span> <span class="nlm-surname">Eastwood</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">P.G.</span> <span class="nlm-surname">Kranz</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">688-692; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3266 </span></div>
  
  
  
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      <div class="highwire-cite-title">CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.K.</span> <span class="nlm-surname">Hoang</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.P.</span> <span class="nlm-surname">Massoglia</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.A.</span> <span class="nlm-surname">Apostol</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.D.</span> <span class="nlm-surname">Lascola</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.D.</span> <span class="nlm-surname">Eastwood</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">P.G.</span> <span class="nlm-surname">Kranz</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">688-692; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3266 </span></div>
  
  
  
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