Abstract
Cervical facet joint nerves (medial branches) 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 (vertebral artery, spinal nerve, etc.) that cannot be seen on fluoroscopy may be visualized on US, enhancing the safety of this intervention.
keywords
Cervical Z-Joint, Facet Joint, Medial Branch, Neck Pain, Third Occipital Nerve, Ultrasound, Whiplash
Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.
Cervical facet joint nerves (medial branches, MB) 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 (vertebral artery, spinal nerve, etc.) that cannot be seen on fluoroscopy may be visualized on US, enhancing the safety of this intervention.
In this chapter, we present an anterolateral approach for cervical MB nerve injections, oftentimes referred to as medial branch blocks, with an out-of-plane technique with in-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.
Out-of-Plane Technique ( Fig. 30C.1 )
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The patient is side-lying, facing the interventionalist (see Fig. 30C.1A ).
Fig. 30C.1
A, Recommended room, interventionalist, transducer and US setup with simulated patient in side-lying position.
B, Ultrasound (US) out-of-plane needle placement image at the targeted MB on the articular pillar “valley.” C , Drawing of relevant structures corresponding to Fig. 30C.1A . Yellow dashed line represents US image borders seen in Fig. 30C.1B . Note that the medial branches lay in the “valleys” of the articular pillars. The Z joints form “peaks.” C, Proper US transducer placement. D, Room and interventionalist injection setup.Related posts:
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