Abstract
Cervical medial branch blocks are commonly performed for the diagnosis and treatment of chronic neck pain and headaches. Although fluoroscopy constitutes the imaging standard for these procedures, recent evidence suggests that ultrasound guidance (USG) can provide similar accuracy coupled with shorter performance times. Moreover the ability to visualize soft tissue structures allows the operator to detect and avoid blood vessels, thus reducing complications related to vascular breach. In this review article, we discussed the technical considerations and evidence supporting the use of USG for cervical medial branch and third occipital nerve blocks.
Highlights
Cervical medial branch blocks (CMBBs) are commonly employed for the diagnosis and management of facet-related pain [1]
We will analyze the evidence pertaining to ultrasound guidance (USG), discuss differences between the 2 imaging modalities and provide a comprehensive technical description of USG CMBB
The C7 medial branches (MB), because of its variable anatomy, requires 2 injections, with half the volume deposited on the superior articular pillar (SAP) and half 3 mm lateral to the latter
Summary
Cervical medial branch blocks (CMBBs) are commonly employed for the diagnosis and management of facet-related pain [1]. The latter constitutes the most important cause of axial neck pain and has been implicated in 40% of all cases [2]. While CMBBs are often used to identify patients for thermo-radiofrequency procedures, they possess an intrinsic therapeutic effect, providing pain relief for several weeks or months [6]. Fluoroscopy constitutes the current imaging standard for CMBB [7]. We will analyze the evidence pertaining to USG, discuss differences between the 2 imaging modalities and provide a comprehensive technical description of USG CMBB
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