Ultrasound-guided cervical facet joint injections

Area of Science:

• Interventional Pain Management
• Musculoskeletal Imaging
• Anatomy and Physiology of the Cervical Spine

Background:

• Cervical facet joints are a frequent source of chronic neck pain.
• Radiofrequency neurotomy is established for facet joint pain, but intra-articular injection efficacy is less defined.
• Ultrasound guidance offers potential for accurate cervical facet joint injections.

Purpose of the Study:

• To determine the accuracy of ultrasound-guided cervical facet joint injections utilizing a lateral technique.
• To describe the specific procedural technique for ultrasound-guided cervical facet joint injections.

Main Methods:

• A cohort study involving 60 ultrasound-guided cervical facet joint injections in 36 patients with facet-mediated pain.
• Injections were performed by an experienced interventionist using a lateral, long-axis or in-plane ultrasound approach.
• Accuracy was assessed via contrast dye arthrography, with patterns interpreted by the operator and an independent imaging specialist.

Main Results:

• The accuracy of ultrasound-guided cervical facet joint injections ranged from 92% to 98%, depending on interpretation criteria.
• Confidence intervals for accuracy were [0.82-0.97, 0.91-1.0] and [0.85-0.99, 0.95-1.00].
• Injections were distributed across levels C2-3 (22%), C3-4 (40%), C4-5 (33%), and C5-6 (5%).

Conclusions:

• Lateral ultrasound-guided cervical facet joint injections can be performed with high accuracy.
• This technique requires a meticulous approach and significant operator skill, similar to fluoroscopy-guided injections.
• Ultrasound guidance provides a viable and accurate method for cervical facet joint interventions.