Ultrasound-Guided Cervical Facet Nerve Blocks (Medial Branch and Third Occipital Nerve)

2015 ◽  
pp. 233-238
Author(s):  
Andreas Siegenthaler
Keyword(s):  
Medial Branch ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Occipital Nerve ◽  
Cervical Facet

Ultrasound-guided third occipital nerve and cervical medial branch nerve blocks

2009 ◽  
Vol 13 (3) ◽  
pp. 128-132 ◽  
Author(s):  
Andreas Siegenthaler ◽  
Samer Narouze ◽  
Urs Eichenberger
Keyword(s):  
Medial Branch ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Occipital Nerve

T711 CERVICAL FACET JOINT NERVE BLOCKS, A NOVEL TECHNIQUE BASED ON ULTRASOUND GUIDED NEEDLE PLACEMENT

2011 ◽  
Vol 5 (S1) ◽  
pp. 98-98
Author(s):  
A. Siegenthaler ◽  
S. Mlekusch ◽  
J. Schliessbach ◽  
M. Curatolo ◽  
U. Eichenberger
Keyword(s):  
Facet Joint ◽  
Needle Placement ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Novel Technique ◽  
Cervical Facet ◽  
Cervical Facet Joint

The Benefit of Therapeutic Medial Branch Blocks after Cervical Operations

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 527-534
Author(s):  
Stephan Klessinger
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Medial Branch Block ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. Objectives: The objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. Study Design: Retrospective practice audit. Setting: Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. Methods: Patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). A positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. All patients with a minimum follow up time of 6 month were included. Results: Of the 312 operations performed, 128 were artificial disc operations, 125 were stand alone cages, and 59 were fusions with cage and plate. Persistent neck pain occurred in 33.3 % of the patients. There was no difference between the patients with neck pain and the whole group of patients. More than half of the patients with neck pain—52.9%—were treated successfully with therapeutic medial branch blocks. Since no further treatment was necessary, the initial treatment was considered successful. Nearly a third—32.2%—of the patients were initially treated successfully, but their pain recurred and further diagnostics and treatments were necessary. In this group of patients, significantly more with double level operations were found (P = 0.003). Patients not responding to the medial branch block were 14.9%. Limitations: This audit is retrospective and observational, and therefore does not represent a high level of evidence. However, to our knowledge, since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists, it appears to be the best available research upon which to recommend treatment and to plan higher quality studies. Conclusions: For persistent postsurgical neck pain only limited therapy recommendations exist. This study suggests treating these patients in a first instance with therapeutic medial branch blocks. The success rate is 52.9 %. Key words: Chronic neck pain, cervical zygapophysial pain, cervical facet joint pain, medial branch blocks, therapeutical cervical facet joint nerve blocks, postsurgery syndrome, pain therapy Pain Physician

scholarly journals Randomized Study Assessing the Accuracy of Cervical Facet Joint Nerve (Medial Branch) Blocks Using Different Injectate Volumes

2010 ◽  
Vol 112 (1) ◽  
pp. 144-152 ◽  
Author(s):  
Steven P. Cohen ◽  
Scott A. Strassels ◽  
Connie Kurihara ◽  
Akara Forsythe ◽  
Chester C. Buckenmaier ◽  
...  
Keyword(s):  
Facet Joint ◽  
False Positive Rate ◽  
Randomized Study ◽  
Lateral Approach ◽  
Medial Branch ◽  
Nerve Blocks ◽  
Significant Difference ◽  
Facet Joint Pain ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background Neck pain is a frequent cause of disability, with facet joint arthropathy accounting for a large percentage of cases. The diagnosis of cervical facet joint pain is usually made with diagnostic blocks of the nerves that innervate them. Yet, medial branch blocks are associated with a high false-positive rate. One hypothesized cause of inaccurate diagnostic blocks is inadvertent extravasation of injectate into adjacent pain-generating structures. The objective of this study was to evaluate the accuracy of medial branch blocks by using different injectate volumes. Methods Twenty-four patients received cervical medial branch blocks, using either 0.5 or 0.25 ml of bupivacaine mixed with contrast. One half of the patients in each group were suballocated to receive the blocks in the prone position and the other half through a lateral approach. Participants then underwent computed tomography of the cervical spine to evaluate accuracy and patterns of aberrant contrast spread. Results Sixteen instances of aberrant spread were observed in nine patients receiving blocks using 0.5 ml versus seven occurrences in six patients in the 0.25 ml group (P = 0.07). Aberrant spread was most commonly observed (57%) when an injection at C3 engulfed the third occipital nerve. Among the 86 nerve blocks, foraminal spread occurred in five instances using 0.5 ml and in two cases with 0.25 ml. The six "missed" nerves were equally divided between treatment groups. No significant difference in any outcome measure was observed between the prone and lateral positions. Conclusions Reducing the volume during cervical medial branch blocks may improve precision and accuracy.

Cervical Facet Nerve Block: Ultrasound

2016 ◽  
Author(s):  
Andreas Siegenthaler
Keyword(s):  
Facet Joint ◽  
Chronic Neck Pain ◽  
Medial Branch ◽  
Lumbar Region ◽  
Nerve Blocks ◽  
Radiofrequency Neurotomy ◽  
Fluoroscopic Control ◽  
Actual Target ◽  
Cervical Facet ◽  
Better Than

The cervical facet joints are well-documented sources of chronic neck pain and headache. Ultrasound may offer the advantage of visualizing the actual target nerves, which is not possible with fluoroscopy. The relevant structures are located much more superficially than in the lumbar spine, hence visibility of the potential targets with ultrasound is expected to be better than in the lumbar region. Besides the ability to perform diagnostic nerve blocks, ultrasound imaging is expected to increase precision of radiofrequency neurotomy due to the ability to localize the exact course of a facet joint supplying nerve. For practitioners with only little experience in cervical sonoanatomy, we recommend performing ultrasound-guided cervical medial branch blocks with parallel fluoroscopic control first till one gains more experience. Correct level determination with ultrasound as described may be difficult for beginners, and the parallel use of fluoroscopy will help developing a “feel” for the procedure.

Cervical Facet Nerve Block and Radio Frequency Ablation: Fluoroscopy

2016 ◽  
Author(s):  
Maarten van Eerd ◽  
Arno Lataster ◽  
Maarten van Kleef
Keyword(s):  
Local Anesthetic ◽  
Facet Joint ◽  
Spinal Column ◽  
Medial Branch ◽  
Nerve Blocks ◽  
Steroid Injections ◽  
Track Record ◽  
Segmental Nerve ◽  
Ramus Medialis ◽  
Cervical Facet

In the cervical spinal column local anesthetic can be injected intra-articularly or adjacent to the ramus medialis (medial branch) of the ramus dorsalis of the segmental nerve. Nerve blocks of the ramus medialis are preferred to an intra-articular block, because it is sometimes technically difficult to position a needle into the facet joint. These procedures are typically performed under fluoroscopy, but there are increasing numbers of studies that describe these procedures with the help of ultrasound. Reports regarding the effects of intra-articular (steroid) injections are limited. There are no comparative studies between intra-articular steroid injections and radiofrequency (RF) therapy. Based on literature about the efficacy of RF treatment and a long track record of safety of RF treatment, many pain practitioners abandon intra-articular injections in favor of RF treatment.

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