American journal of physical medicine & rehabilitation · 2026
Optimum Sonoanatomical Approach for Selective Cervical Nerve Root Block: Evaluation of Three Different Needle Pathways in Cadavers and Volunteers.
СтатьяНазвание и аннотация: Перевод в очереди
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Yürük Damla, Akkaya Ömer Taylan, Yilmaz Mehmet, Güngör Yiğit, Cömert Ayhan
Аннотация
OBJECTIVE: To identify the safest approach for selective cervical spinal nerve block (SCSNB) using sonoanatomic evaluation of spinal nerves (SNs) and adjacent vascular structures.
DESIGN: This study included 50 healthy volunteers and 7 cadavers. In volunteers, C5-C7 SNs were evaluated using ultrasound. Three virtual needle trajectories posterior-to-anterior (P-A), anterior-to-posterior (A-P), and lateral-to-medial (L-M) were assessed within a region of interest. Cadaveric dissections examined morphometric relationships between the vertebral artery (VA), ascending cervical artery (ACA), deep cervical artery (DCA), and SNs.
RESULTS: Vascular structures increased from C5 to C7 (P < 0.001), and the L-M trajectory contained fewer vessels than the A-P and P-A trajectories (P < 0.001). Cadaveric findings demonstrated caudal increases in SN thickness and arterial diameters, with the VA, ACA, and DCA positioned closer to spinal grooves at lower levels.
CONCLUSION: Lower cervical levels show increased vascular density and vessel proximity to SNs. The L-M trajectory has the fewest vessels and appears safest for SCSNB. The L-M trajectory demonstrated the lowest vascular density and may represent a relatively safer anatomical corridor for SCSNB; however, its clinical performance should be confirmed by future interventional studies.
DESIGN: This study included 50 healthy volunteers and 7 cadavers. In volunteers, C5-C7 SNs were evaluated using ultrasound. Three virtual needle trajectories posterior-to-anterior (P-A), anterior-to-posterior (A-P), and lateral-to-medial (L-M) were assessed within a region of interest. Cadaveric dissections examined morphometric relationships between the vertebral artery (VA), ascending cervical artery (ACA), deep cervical artery (DCA), and SNs.
RESULTS: Vascular structures increased from C5 to C7 (P < 0.001), and the L-M trajectory contained fewer vessels than the A-P and P-A trajectories (P < 0.001). Cadaveric findings demonstrated caudal increases in SN thickness and arterial diameters, with the VA, ACA, and DCA positioned closer to spinal grooves at lower levels.
CONCLUSION: Lower cervical levels show increased vascular density and vessel proximity to SNs. The L-M trajectory has the fewest vessels and appears safest for SCSNB. The L-M trajectory demonstrated the lowest vascular density and may represent a relatively safer anatomical corridor for SCSNB; however, its clinical performance should be confirmed by future interventional studies.