Facet block injections: Cervical, lumbar, sacroiliac joint

Cervical medial branch block injection

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  Place the patient prone on the pain management table. Rotate the patient’s neck so that the symptomatic side is down. This allows the vertebral artery to be positioned farther beneath the articular pillar, creates greater accentuation of the cervical waists, and prevents the jaw from being superimposed. Aseptically prepare and drape the side to be injected.

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  Identify the target location using anteroposteriorly directed fluoroscopy. Each cervical facet joint from C3-4 to C7-T1 is supplied from the medial nerve branch above and below the joint that curves consistently around the “waist” of the articular pillar of the same numbered vertebrae. To block the C6 facet joint nerve supply, anesthetize the C6 and C7 medial branches.

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  Proper needle placement for a posterior approach to C4 and C6 medial branch blocks ( Fig. 12.1 ). Second cervical ganglion (g), third occipital nerve (ton), C2 ventral ramus (C2vr), and lateral atlantoaxial joint (laaj) are noted. a, articular facet; mb, medial branch.

  

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  Insert a 22- or 25-gauge, 3½-inch spinal needle perpendicular to the pain management table and advance it under fluoroscopic control ventrally and medially until contact is made with periosteum. Direct the spinal needle laterally until the needle tip reaches the lateral margin of the waist of the articular pillar and then direct the needle until it rests at the deepest point of the articular pillar’s concavity under fluoroscopy.

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  Remove the stylet. If there is a negative aspirate inject 0.5 mL of 0.75% preservative-free bupivacaine.