Abstract
Cervical facet zygapophysial (facet) joint (Z-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 that cannot be seen on fluoroscopy may be visualized on US, enhancing the safety of this intervention.
Keywords
facet joint nerve, headaches, medial branch block, neck pain, readiofrequency neurotomy, ultrasound guided, Z-joint, zygapophysial joint
Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.
Cervical facet/zygapophysial joint (Z-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 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 medial branch block or radiofrequency neurotomy with an in-plane technique with 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 the ionizing radiation.
In-Plane Technique ( Fig. 30G.1 )
- ▪
The patient is side-lying, facing the US unit. The interventionalist is behind the patient (see Fig. 30G.1A ).
Fig. 30G.1
A, Suggested room, interventionalist, transducer, and US unit set up for side lying procedure.
- ▪
The US unit is positioned on the opposite side to the interventionalist and in line with the transducer (as described in Chapter 4 ).
- ▪
Utilize a linear transducer, as the structures of interest are relatively superficial.
- ▪
Identify the vertebral artery (VA) at C2 (see Chapter 4 ).
- ▪
Use the techniques described in Chapter 4 to identify and mark the target level.
- ▪
Start with the transducer in long axis to the cervical spine. Identify the facet joints and articular pillars that appear respectively as peaks and troughs. ( Fig 30G.1 B,C ).
- ▪
After identifying the target level, rotate the transducer 90 degrees (short-axis view of the cervical spine) (see Fig. 30G.1D ).
- ▪
Stay over the hyperechogenic articular pillar that is slightly deeper and flatter in contrast to the adjacent facet joint capsules, which appear rounded, peaked, and superficial in comparison. The medial branch nerve is located at the trough on the articular pillar between the facet joints (peaks).
- ▪
Translate the transducer anteriorly so that the targeted structure is closer to the point of planned needle entry.
- ▪
Using an in-plane technique, insert the needle with a slightly oblique trajectory (posterolateral to anteromedial) and advance to the target.
Related posts:
Introduction: How to Use This Atlas
Caudal Epidural Steroid Injection: Ultrasound Guidance
Lumbar Transforaminal Epidural Steroid Injection—Infraneural Approach: Fluoroscopic Guidance
Thoracic Zygapophysial Joint Intraarticular Injection—Posterior Approach: Fluoroscopic Guidance
Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach: Fluoroscopic Guidance
Lateral Femoral Cutaneous Nerve Injection: Ultrasound Guidance
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
