Cervical Zygapophysial Intraarticular Injection—Posterior Approach: Ultrasound Guidance

Abstract

Cervical zygapophysial joints (Z-joints) can be safely, effectively, and efficiently accessed with ultrasound (US) guidance by an experienced interventionalist. The structures involved are relatively superficial and, thus, lend themselves well to US visualization. Furthermore, radiolucent structures that cannot be seen on fluoroscopy may be visualized on US, enhancing the safety of this intervention.

Keywords

facet joint injection, US, ultrasound guided, zygapophysial joint, Z-joint neck pain headaches

Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.

Cervical zygapophysial joints (Z-joints) can be safely, effectively, and efficiently accessed with ultrasound (US) guidance by an experienced interventionalist. The structures involved are relatively superficial and, thus, lend themselves well to US visualization. Furthermore, radiolucent structures that cannot be seen on fluoroscopy may be visualized on US, enhancing the safety of this intervention.

Here we present a posterior approach for cervical Z-joint intraarticular injection with an in-plane technique and out-of-plane confirmation. This technique can be used alone or in conjunction with conventional fluoroscopy in a hybrid technique, thus, eliminating or minimizing exposure to ionizing radiation.

In-Plane Technique ( Fig. 30E.1 )

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The patient is side-lying, facing the US unit. The interventionalist is behind the patient (see Fig. 30E.1A ).

Fig. 30E.1

A, Suggested room, interventionalist, transducer, and US unit setup for side lying proceedure.
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The US unit is positioned on the opposite side to the interventionalist and in line with the transducer (as described in Chapter 4 ).
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Utilize a linear transducer, as the structures of interest are relatively superficial.
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Identify the vertebral artery at C2 (see Chapter 4 ).
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Use the techniques described in Chapter 4 to identify and mark the target level.
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Start with the transducer in long axis to the cervical spine. Identify the facet joint and articular pillars.
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After identifying the target joint, rotate the transducer 90 degrees (short axis view of the cervical spine) (see Fig. 30E.1D ).
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Stay over the target facet joint that is relatively superficial and rounded in comparison to the hyperechogenic adjacent articular pillars, which are slightly deeper and flatter.
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Translate the transducer anteriorly so that the targeted joint is close to the point of planned needle entry.
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Using an in-plane technique, insert the needle with a slightly oblique trajectory (posterolateral to anteromedial) and advance to the target joint (see all Figs 30E.1 ).