How is a cervical facet block administered for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Injection techniques described by Bogduk et al are usually accomplished with the patient in a prone position; however, if necessary, the patient can be in the sitting position. A 22-gauge or 25-gauge needle is directed into the midpoint of the target joint from a posterior paraspinal site, usually 2 or more segments caudally and along an oblique trajectory that coincides with the plane of the joint as viewed by C-arm fluoroscopy. The needle is directed through the skin upward and ventrally through the posterior neck muscles until it touches the posterior aspect of the targeted facet; the needle then can be readjusted until it enters the joint cavity.

Repeated PA and lateral screening by fluoroscopy provides the operator with assurance that the needle maintains its intended course. The bevel of the needle should enter the target joint at its midpoint. [19, 20]

Once the needle is located in the joint, injection of contrast medium should produce an arthrogram and confirm accurate needle placement. Contrast injection may induce a pain response from the awake patient. The practitioner should carefully record whether the contrast-induced pain is concordant (identical to the pain under investigation), partly concordant (similar, but not identical), or non-concordant (a different, new pain experience).

After the patient's pain assessment is recorded, the injection of LA with or without corticosteroids provides further diagnostic and treatment information, including whether or not the pain can be satisfactorily ablated with intra-articular treatment or treatment may provide better relief if aimed at the joint’s innervation by blocking the pertinent medial branches of the dorsal root rami. The medial branch block technique can also be used to determine the symptomatic level, although this may be confounded due to the facet joint’s characteristic innervation, which is received from 2 spinal levels. Each joint receives nociceptive afferents from the dorsal root ramus at the same level and from dorsal root ramus of the vertebral level above. [19, 20, 21]


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