Injection Technique for Cervicothoracic Interspinous Bursitis

Indications and Clinical Considerations

Injection of the cervicothoracic bursae can serve as both a diagnostic and a therapeutic maneuver in patients thought to be suffering from cervicothoracic bursitis. Cervicothoracic interspinous bursitis is an uncommon cause of pain in the lower cervical and upper thoracic spine. The interspinous ligaments of the lower cervical and upper thoracic spine and their associated muscles are susceptible to the development of acute and chronic pain symptomatology following overuse. It is thought that bursitis is responsible for this pain syndrome. Frequently, the patient presents with midline pain after prolonged activity requiring hyperextension of the neck, such as painting a ceiling or following the prolonged use of a computer monitor with too high of a focal point. The pain is localized to the interspinous region between C7 and T1 and does not radiate. It is constant, dull, and aching in character. The patient may attempt to relieve the constant ache by assuming a posture of dorsal kyphosis with a thrusting forward of the neck ( Fig. 27.1 ). The pain of cervicothoracic interspinous bursitis often improves with activity and is made worse with rest and relaxation.

The patient suffering from cervicothoracic bursitis will present with the complaint of dull, poorly localized pain in the lower cervical and upper thoracic region. The pain spreads from the midline to the adjacent paraspinous area, but it is nonradicular in nature. The patient often holds the cervical spine rigid with the head thrust forward to splint the affected ligament and bursae. Flexion and extension of the lower cervical spine and upper thoracic spine tend to cause more pain than does rotation of the head. The neurologic examination of patients suffering from cervicothoracic bursitis should be normal. Focal or radicular neurologic findings suggest a central or spinal cord origin of the patient’s pain symptomatology and should be followed up with magnetic resonance imaging (MRI) scan of the appropriate anatomic regions.

MRI scans of the lower cervical and upper thoracic spine should be performed on all patients thought to be suffering from cervicothoracic bursitis ( Fig. 27.2 ). Ultrasound imaging may also help identify and delineate interspinous masses ( Fig. 27.3 ). Electromyography of the brachial plexus and upper extremities is indicated if there are neurologic findings or pain radiating into the arms. Clinical laboratory testing consisting of a complete blood cell count, automated chemistry profile, antinuclear antibody testing, and erythrocyte sedimentation rate are indicated to rule out infection, collagen vascular disease including ankylosing spondylitis, and malignancy that may mimic the clinical presentation of cervicothoracic bursitis. Injection of the affected interspinous bursae with local anesthetic and steroid may serve as both a diagnostic and a therapeutic maneuver and may help strengthen the diagnosis of cervicothoracic bursitis. Plain radiography of the sacroiliac joints is indicated if ankylosing spondylitis is considered in the differential diagnosis.