Chapter 33 Cervical Zygapophysial Joint Nerve (Medial Branch) Injection, Lateral Approach

Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.

The cervical Z-joints are a well-documented source of acute and chronic neck pain. Symptomatic cervical Z-joints typically produce axial pain. In addition, the upper Z-joints may demonstrate sclerotomal referral patterns that radiate superiorly and anteriorly to involve the head, whereas the lower joints demonstrate patterns that radiate inferiorly and laterally to involve the shoulder and the upper thoracic region.¹ The patient’s history, physical examination, and imaging studies will be suggestive of but not specific for Z-joint pain. The standard for the diagnosis of Z-joint pain is either possibly intraarticular Z-joint injection or medial branch blockade.² Cervical medial branch blocks may have a therapeutic benefit.³ Each Z-joint is innervated by two medial branch nerves. Typically, a lateral projection is best suited for cervical medial branch blockade, especially for the upper segments. The foraminal oblique view (Chapter 3) will assist in visualizing the lower segments, particularly at C7, which may be obscured on a lateral view.

Note that this is one of the few procedures in which the trajectory view is the lateral view (i.e., one of the multiplanar views).

Special attention should be made to Figure 33–10, which illustrates the variability of the cervical medial branch nerves’ anatomical courses.

Trajectory View (Figure 33–1)

Tilt the fluoroscope cephalad or caudad.

Line up the vertebral superior endplate and the inferior endplate to the appropriate orientation.

Superimpose the articular pillars.

Figure 33–1 A, Fluoroscopic image of a trajectory view with the needle position along the cervical medial branches of C3 and C4. Ideally, the needles should be visualized down their shaft as a “hubogram” (not shown). B, Radiopaque structures, trajectory view. C, Radiolucent structures, trajectory view.

Oblique the fluoroscope minimally (i.e., keep it near neutral).

Note that a slight degree of obliquity may be required to superimpose the articular pillars to obtain a trapezoid view.

Confirm the level by counting inferiorly from C2.

The target needle destination depends on the targeted medial branch.

The needle is advanced by remaining parallel with the fluoroscopic beam until the periosteum is encountered.

To differentiate ipsilateral from contralateral cervical medial branches, use one of the techniques described in Chapter 3.

Optimal Needle Position in Multiplanar Imaging

The multiplanar images include lateral, anteroposterior, and foraminal oblique.

Optimal Needle Positioning in the Lateral View

For cervical medial branch blocks from the lateral approach, the lateral view is the same as the trajectory view.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related posts:

Atlantoaxial Joint Intraarticular Injection Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Thoracic Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Lumbar Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Interlaminar Epidural Steroid Injection, Paramedian Approach

Stay updated, free articles. Join our Telegram channel

Join