Thoracic Zygapophysial Joint Nerve (Medial Branch) Injection—Posterior Approach: Fluoroscopic Guidance

Abstract

The courses of the C8 and thoracic medial branch nerves are described in the introduction of Chapter 22 and demonstrated in Chapter 22D .

Key Words

back pain, diagnostic, facet, facet joint nerve, fluoroscopy, medial branch, nerve block, spondylosis, zygapophysial joint, zygapophysial joint nerve

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

The courses of the C8 and thoracic medial branch nerves are described in the introduction of Chapter 22 and demonstrated in Chapter 22D .

For C8 and thoracic medial branch blocks, the needle tip is placed at the superolateral edge of the transverse process, where each medial branch nerve is located. The C8 and T1-T10 medial branch nerves are injected in this manner, whereas the T11 and T12 medial branch nerves are injected using similar landmarks that are used when injecting the lumbar medial branch nerves.

The needle trajectory for C8 and T1-T10 medial branch injections is more sagittal, in contrast to the thoracic radiofrequency (RF). The spinal needle is placed using a fluoroscopic AP view, which is the trajectory view for injecting the medial branch nerves. The needle tip position and depth are confirmed with AP and lateral views. Ipsilateral oblique views are recommended for the T11 and T12 medial branch nerves because their locations are similar to the lumbar medial branch nerves.

Trajectory View ( Fig. 22B.1 )

Optimal Needle Position in Multiplanar Imaging

The Trajectory View (AP) Is Also a Multiplanar View

The injection level is confirmed with the AP view.

The needle is placed parallel to and advanced within the fluoroscopic beam to the superolateral edge of the transverse process until the needle tip contacts the periosteum.

Notes on Positioning in the Trajectory View