using ultrasound for interventional techniques for cervical pain management, cervical facet pain ,cervical radicular pain,evidence based interventions

1. By
Mohamed Abuelnaga
Lecturer Of Anaesthesia
Suez Canal University

2.  Why ultrasound ?
 Ultrasound limitations ?
 Evidence Based cervical Interventions ?
 What will we see by ultrasound ?

3. 1. Radiation-free imaging.
2. Short procedure time compared to fluoroscopy or CT
and the need to insert only 1 needle.
3. Ability to identify and avoid vessels in the trajectory
of the needle.
4. Dynamic imaging.

4.  Not seeing a small blood vessel does not necessarily mean it does
not exist. It could be either the limitation of the sonographic
resolution or the limitation of the operator’s experience.
 Also, visualizing such small nerves (cervical medial branches and
third occipital nerve) can be very challenging and requires special
training and experience.
 Fluoroscopically guided C7 medial branch blocks are challenges,
and the sonographically guided technique is no exception.

5. Evidence based cervical
interventions

6. Cervical facet pain

12.  Cervical Facet Joint Injections
 Cervical Medial Branch Block
 Identifying Cervical Spine Level &cervical
nerve roots

15.  Posterior Approach. Why?
1. Multilevel injections can be performed with the same view
and may even use a single needle entry point.
2. Bilateral injections can be performed without the need to
change position.
3. The needle is inserted in plane from a caudal to cranial
direction

16. Sagittal (longitudinal) sonogram at the level of the articular pillars showing
the hyperechoic articular processes of the facet joints as the saw sign and the
anechoic facet joint space in between.

19. Short-axis (transverse) sonogram at
the C6 level

20. Short-axis (transverse) sonogram at
the C7 level

21. Short-axis (transverse) sonogram at
the C5 level

22. 1-Ultrasound guided pain management interventions
is good alternative to both fluoroscopy and CT
guidance
2-Transforaminal Cervical nerve root injection may
be fatal so it is not recommended for management of
cervical radicular pain
3- Non-particulate steroid injection has fewer
complications when compared to particulate steroids