What is the lateral approach to the cervical zygapophyseal joints in therapeutic injections for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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The lateral approach to the cervical zygapophyseal joints described by Bogduk et al is performed with the patient in the lateral position. In these cases, the patient may be gently rolled ventrally or dorsally, or the x-ray beam adjusted to tilt along the transverse plane of the target joint. The needle is directed, then advanced, toward the superior or inferior articular process at the midpoint of the target joint. This is done carefully so that the needle does not pass deeper into or through the joint into the epidural space.

When the needle reaches the joint, the operator gently probes and pierces the capsule to enter the joint space, which can be sensed by the operator as a loss of resistance. Only minimal penetration is required. A small amount of contrast medium (0.3 mL) is used to obtain an arthrogram and to record the patient's pain response. The C2-3 zygapophyseal joints are blocked using the lateral approach already described. This level is considered important, and especially pertinent to neurologists, because several studies suggest that this articulation level is the most common source of cervicogenic headache.

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