Ultrasound-guided cervical facet joint injections

BACKGROUND CONTEXT: Cervical facet joints are a common cause of chronic neck pain. Radiofrequency neurotomy is a validated treatment technique for cervical facet joint pain, but the role of intra-articular injections is less clear. Ultrasound guidance can be used to inject the cervical facet joints. Given that the accuracy of any injection technique is likely to affect treatment outcomes, it would be useful to know the accuracy of ultrasound-guided cervical facet joint injections. PURPOSE: The primary purpose of this study was to determine the accuracy of ultrasound-guided cervical facet joint injections using a lateral technique. The secondary purpose was to describe the technique. STUDY DESIGN/SETTING: Cohort study of ultrasound-guided cervical facet joint injections performed by an experienced spine and ultrasound interventionist, as assessed by contrast dye arthrography at a community interventional spine practice. PATIENT SAMPLE: Sixty joints in 36 patients with facet mediated pain. OUTCOME MEASURES: Accuracy of ultrasound-guided injections as determined by the percent of fluoroscopic contrast dye patterns interpreted to be intra-articular by the operator and an independent imaging specialist. Confidence intervals were determined using binomial “exact” and normal approximation to the binomial calculations. METHODS: Ultrasound using a long-axis or in-plane approach was used to guide a needle into a facet joint, followed by injection of contrast dye and a lateral fluoroscopic image. The dye pattern was interpreted by the operator. Depending on the pattern, local anesthetic and corticosteroid were injected. The patient was asked whether their neck pain had resolved. If not resolved, another joint was selected and the process was repeated. At the end of the study, all of the contrast patterns were interpreted independently by the imaging specialist. Funding was through a 501(c)(3) foundation without any commercial or sponsorship interests. RESULTS: The accuracy of ultrasound-guided cervical facet joint injections using the lateral technique ranged from 92% to 98% depending on the criteria used to confirm an intra-articular contrast pattern (95% CI: 0.82–0.97 to 0.91–1.0, and 0.85–0.99 to 0.95–1.00). The distribution of injections was C2–3 (22%), C3–4 (40%), C4–5 (33%) and C5–6 (5%). CONCLUSIONS: Cervical facet joint injections can be performed with a high degree of accuracy using a lateral ultrasound-guided technique. As with fluoroscopy-guided cervical facet joint injections, the technique requires a careful approach and a high degree of skill.