Selective Cervical Root Block for Chronic Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Currently, selective cervical nerve root injections are recommended under the guidance of
      fluoroscopy, ultrasonography and computed tomography in patients with chronic cervical
      radicular pain who do not respond to conservative treatments and are not planned for surgery.
      Various serious complications, mainly vascular, have been reported in the literature. These
      complications include vertebral artery injury, spinal cord and brain stem infarction. The
      arteries of the cervical spinal cord are the vertebral, ascending, and deep cervical arteries
      arising from the aorta.The arteries arising from these main arteries and reaching the
      intervertebral foramen are called segmental arteries, the arteries reaching the epidural
      region from the intervertebral foramen and the radicular arteries, and the branches reaching
      the spinal cord are called the medullary artery. These small arteries supplying the spinal
      cord lie close to the spinal nerve in the foramen between the anterior and posterior
      trabercules. Vasospasm or embolism, which occurs as a result of direct needle trauma to these
      vascular structures around the target nerve or injection of particulate steroids, are the
      most common causes of complication development.

      The aim of our study is to identify the vascular structures around the foramen in selective
      cervical root injection, which has proven effectiveness in cervical radicular pain, to
      determine the most reliable method for positioning the needle while reaching the target nerve
      under US guidance and to prevent possible complications.
    

Detailed description: 
      A total of 50 healthy volunteers and 10 patients with cervical radicular pain, between the
      ages of 18-70, height above 155 cm and body mass index 25 and below, in the Algology Clinic
      of the University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital
      will be included in the study. Those who have structural disorders in the neck region and who
      have undergone neck surgery will not be included in the study. 7 cadavers will be included in
      the study in Ankara University Faculty of Medicine, Department of Anatomy.

      2 Algology specialists from Health Sciences University Dışkapı Yıldırım Beyazıt Training and
      Research Hospital Algology Clinic and 3 doctors from Ankara University Medical Faculty
      Anatomy Department will participate in the study. Two Algology Specialists will record the
      localization and number of cervical spinal nerve, transverse process cornes and surrounding
      vascular structures at cervical C4-5-6-7 levels in healthy volunteers by Doppler USG. Again,
      two Algology Specialists will apply cervical root block to patients with cervical radicular
      pain guided by Doppler USG, and pain scores of the patients will be evaluated with VAS
      (visual analog scale) before and after the procedure. Seven formalin-containing human
      cadavers will be examined by 3 anatomy doctors at Ankara University Faculty of Medicine,
      Department of Anatomy to determine the morphology of the spinal nerve, vertebral artery,
      assending and deep arteries in the cervical foraminal region, as well as the radicular
      arteries.

      Demographic characteristics (age, gender, BMI, body height) of 50 volunteers and 10 patients
      with cervical radicular pain will be recorded. The pain intensity of 10 patients with
      cervical radicular pain will be determined and recorded with the VAS (visual analog scale)
      score before the procedure and at 1,2,3 and 4 weeks after the procedure, by calling the
      patients for control.

      The cadavers will be dissected after being placed in the supine position and bilaterally from
      C4 to C7. Neurovascular complexes will be defined.

      Efforts will be made to determine the most appropriate needle pathway to reach the target
      cervical nerve.
    

Intervention name(s): Ultrasound-guided selective cervical nerve root block
Intervention type(s): Procedure
Intervention description(s): The volunteer will be placed in the lateral decubitus position with the examined side up and the ultrasonographic examination will be started. Using a high frequency 6-18 MHz linear transducer, scanning in the cephalad and caudal direction until the cervical tubercles are identified in the short axis of the vertebra at the cricoid level, the localization and number of the target nerve root and vascular structures in the foraminal opening between the anterior and posterior tubercles of the transverse process from C4 to C8. will be defined as Unlike healthy volunteers, local anesthetic and steroid injections will be administered to the target nerve.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Screening
Keywords: Sonoanatomy; Cervical nerve root block; Neck pain