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Cervical medial branch block

Donghwi Park, Min Yong Seong, Ha Yong Kim, Ju Seok Ryu
Ultrasound-guided cervical medial branch block (CMBB) is commonly performed to diagnose and treat head, neck, and shoulder pain. However, its use at the C7 level has been shown to be less accurate than at other levels, which may increase the chance of injury owing to the imprecision of needle site provided by the ultrasound guide. We report the first case of iatrogenic spinal cord injury from an ultrasound-guided C7 CMBB. The patient, upon receiving this procedure, had fainted shortly after experiencing an electrical sensation that ran from the neck to the toe...
September 8, 2016: American Journal of Physical Medicine & Rehabilitation
Mark-Friedrich B Hurdle
As the population ages, more patients are developing degenerative changes of the spine and associated pain. Although interventional procedures for axial and radicular spine pain have been available for decades, common imaging modalities have relied on ionizing radiation for guidance. Over the past decade, ultrasound has become increasingly popular to image both peripheral musculoskeletal and axial structures. This article reviews the use of ultrasound in the guidance of spine procedures, including cervical and lumbar facet injections and medial branch blocks, third occipital nerve blocks, thoracic facet and costotransverse joint injections, sacroiliac joint injections, and caudal and interlaminar epidural injections...
August 2016: Physical Medicine and Rehabilitation Clinics of North America
Mats Persson, Jan Sörensen, Björn Gerdle
OBJECTIVE: This study explores the prevalence of facet joint pain in chronic Whiplash Associated Disorder (WAD). DESIGN: Forty-seven patients with chronic WAD were scheduled for medial branch blocks of the cervical spine. METHODS: The patient's localization of the pain together with established pain maps guided to the first level of zygapophyseal joint to be tested. The joint was anesthetized by injecting bupivacaine (0.5 ml; 5 mg/ml) to the medial branches of the cervical dorsal rami above and below the joint...
March 27, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Alexander Bautista, Alisher Dadabayev, Ellen Rosenquist, Jianguo Cheng
We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable cardioverter defibrillator (AICD).Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA of the facet joints. One presented with axial neck pain and the other with axial back pain. The histories and physical examinations were consistent with facetogenic pain. Diagnostic medial branch block resulted in more than 70% pain relief lasting for several days, allowing patients to perform routine daily activities without significant pain...
March 2016: Pain Physician
Roderick J Finlayson, John-Paul B Etheridge, Pornpan Chalermkitpanit, Worakamol Tiyaprasertkul, Bill Nelems, De Q H Tran, Marc A Huntoon
BACKGROUND AND OBJECTIVES: Compared with the thoracic and lumbar spine, transforaminal epidural injections and medial branch blocks in the cervical spine are associated with a higher incidence of neurological complications. Accidental breach of small periforaminal arteries has been implicated in many instances. In this observational study, using ultrasonography, we surveyed the incidence of periforaminal bloods vessels in the cervical spine. METHODS: Patients undergoing ultrasound-guided cervical medial branch blocks were scanned using color power and pulsed wave Doppler...
March 2016: Regional Anesthesia and Pain Medicine
J Artner, S Klessinger
Fluoroscopy-guided interventions on facet joints have been used for decades for the symptomatic management of pain in spinal disorders. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. Pulsed fluoroscopy is one of the most widely used and well-accepted tools for these procedures. This article presents a technical overview of commonly used fluoroscopy-guided interventions on the facet joints of the cervical and lumbar spine, such as facet joint injection, blockade of the medial nerve branches and radiofrequency ablation...
October 2015: Der Radiologe
Young Hoon Jeon, Sae Young Kim
BACKGROUND: The most definitive diagnosis of neck pain caused by facet joints can be obtained through cervical medial branch blocks (CMBBs). However, intravascular injections need to be carefully monitored, as they can increase the risk of false-negative blocks when diagnosing cervical facet joint syndrome. In addition, intravascular injections can cause neurologic deficits such as spinal infarction or cerebral infarction. Digital subtraction angiography (DSA) is a radiological technique that can be used to clearly visualize the blood vessels from surrounding bones or dense soft tissues...
April 2015: Korean Journal of Pain
Roderick J Finlayson, John-Paul B Etheridge, Worakamol Tiyaprasertkul, Bill Nelems, De Q H Tran
BACKGROUND: Because of its location in the lower neck and anatomical variability, the C7 medial branch represents a challenging target for local anesthetic blocks. Although ultrasound (US) guidance offers an alternative to fluoroscopy for C3 to C6 cervical medial branch blocks (CMBBs), its use at the C7 level has not been examined. We hypothesized that US, using a biplanar imaging technique, could provide a shorter performance time than conventional fluoroscopy for C7 CMBB. METHODS: Fifty patients undergoing C7 CMBB were randomized to fluoroscopy or US guidance...
January 2015: Regional Anesthesia and Pain Medicine
Tae Dong Kweon, Ji Young Kim, Hye Yeon Lee, Myung Hwa Kim, Youn-Woo Lee
BACKGROUND AND OBJECTIVES: Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. METHODS: Twenty cervical specimens were harvested from 20 adult cadavers. The anatomical parameters of the C4-C7 cervical medial branches were measured. The 3-dimensional computed tomography reconstruction images of the bone were also analyzed...
November 2014: Regional Anesthesia and Pain Medicine
Shin Jae Kim, Myeong Jin Ko, Young Seok Lee, Seung Won Park, Young Baeg Kim, Chan Chung
OBJECTIVE: Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. METHODS: This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years...
June 2014: Korean Journal of Spine
Geoff M Schneider, Gwendolen Jull, Kenneth Thomas, Ashley Smith, Carolyn Emery, Peter Faris, Chad Cook, Bevan Frizzell, Paul Salo
OBJECTIVE: To derive a clinical decision guide (CDG) to identify patients best suited for cervical diagnostic facet joint blocks. DESIGN: Prospective cohort study. SETTING: Pain management center. PARTICIPANTS: Consecutive patients with neck pain (N=125) referred to an interventional pain management center were approached to participate. INTERVENTIONS: Subjects underwent a standardized testing protocol, performed by a physiotherapist, prior to receiving diagnostic facet joint blocks...
September 2014: Archives of Physical Medicine and Rehabilitation
Laxmaiah Manchikanti, Kimberly A Cash, Vidyasagar Pampati, Yogesh Malla
STUDY DESIGN: A randomized, double-blind, active-controlled trial. OBJECTIVE: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain. SUMMARY OF BACKGROUND DATA: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population...
2014: International Journal of Medical Sciences
Roderick J Finlayson, John-Paul B Etheridge, Worakamol Tiyaprasertkul, Bill Nelems, De Q H Tran
BACKGROUND: Ultrasound (US) guidance offers an alternative to fluoroscopy for medial branch blocks of the upper cervical spine, but it may be less accurate for blocks at the C5 and C6 levels. We hypothesized that a modified technique using biplanar US imaging would facilitate level identification and provide greater accuracy for the lower cervical spine. METHODS: Forty patients with chronic neck pain underwent US-guided blocks of the C5 and C6 medial branches. For each level, 0...
March 2014: Regional Anesthesia and Pain Medicine
Karina Gritsenko, William Caldwell, Naum Shaparin, Amaresh Vydyanathan, Boleslav Kosharskyy
Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus...
January 2014: Pain Physician
V T Lehman, R C Murphy, T J Kaufmann, F E Diehn, N S Murthy, J T Wald, K R Thielen, K K Amrami, J M Morris, T P Maus
BACKGROUND AND PURPOSE: The clinical impact of facet joint bone scan activity is not fully understood. The hypothesis of this study is that facet joints targeted for percutaneous treatment in clinical practice differ from those with reported activity on technetium Tc99m methylene diphosphonate SPECT/CT. MATERIALS AND METHODS: All patients with a technetium Tc99m methylene diphosphonate SPECT/CT scan of the lumbar or cervical spine who underwent subsequent percutaneous facet joint steroid injection or comparative medial branch blocks at our institution between January 1, 2008, and February 19, 2013, were identified...
March 2014: AJNR. American Journal of Neuroradiology
Laxmaiah Manchikanti, Salahadin Abdi, Sairam Atluri, Ramsin M Benyamin, Mark V Boswell, Ricardo M Buenaventura, David A Bryce, Patricia A Burks, David L Caraway, Aaron K Calodney, Kimberly A Cash, Paul J Christo, Steven P Cohen, James Colson, Ann Conn, Harold Cordner, Sareta Coubarous, Sukdeb Datta, Timothy R Deer, Sudhir Diwan, Frank J E Falco, Bert Fellows, Stephanie Geffert, Jay S Grider, Sanjeeva Gupta, Haroon Hameed, Mariam Hameed, Hans Hansen, Standiford Helm, Jeffrey W Janata, Rafael Justiz, Alan D Kaye, Marion Lee, Kavita N Manchikanti, Carla D McManus, Obi Onyewu, Allan T Parr, Vikram B Patel, Gabor B Racz, Nalini Sehgal, Manohar Lal Sharma, Thomas T Simopoulos, Vijay Singh, Howard S Smith, Lee T Snook, John R Swicegood, Ricardo Vallejo, Stephen P Ward, Bradley W Wargo, Jie Zhu, Joshua A Hirsch
OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. METHODOLOGY: Systematic assessment of the literature. EVIDENCE: I. Lumbar Spine • The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair. • The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks...
April 2013: Pain Physician
Steven P Cohen, Julie H Y Huang, Chad Brummett
Facetogenic pain, also known as zygapophysial joint pain, is a frequent cause of mechanical spine pain. Diagnostic blocks (for example, medial branch blocks [MBBs]) are the only reliable approach to identify facet joints as the source of neck or back pain. In the absence of a reference standard, MBBs actually serve more of a prognostic than diagnostic role, enabling the selection of patients who might respond to radiofrequency denervation treatment--the standard treatment for facet joint pain. Using double blocks reduces the false-positive rate of MBBs, but will invariably reduce the overall treatment success rate...
February 2013: Nature Reviews. Rheumatology
Frank J E Falco, Laxmaiah Manchikanti, Sukdeb Datta, Bradley W Wargo, Stephanie Geffert, David A Bryce, Sairam Atluri, Vijay Singh, Ramsin M Benyamin, Nalini Sehgal, Stephen P Ward, Standiford Helm, Sanjeeva Gupta, Mark V Boswell
BACKGROUND: The prevalence of chronic, recurrent neck pain is approximately 15% of the adult general population. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 67% of these patients, when disc herniation, radiculitis, and discogenic are not pathognomic. However, these studies also have shown false-positive results in 27% to 63% of the patients with a single diagnostic block. There is also a paucity of literature investigating therapeutic interventions of cervical facet joint pain...
November 2012: Pain Physician
Han-Il Lee, Yong-Sook Park, Tack-Geun Cho, Seung-Won Park, Jeong-Taik Kwon, Young-Baeg Kim
OBJECTIVE: Chronic neck or back pain can be managed with various procedures. Although these procedures are usually well-tolerated, a variety of side effects have been reported. In this study we reviewed cases of unexpected temporary adverse events after blocks and suggest possible causes. METHODS: We reviewed the records of patients treated with spinal pain blocks between December 2009 and January 2011. The types of blocks performed were medial branch blocks, interlaminar epidural blocks and transforaminal epidural blocks...
September 2012: Journal of Korean Neurosurgical Society
Brian R Theodore, Sola Olamikan, Renee V Keith, Michael Gofeld
OBJECTIVE: The criterion commonly used to determine whether radiofrequency neurotomy may be recommended is based on patient-reported, short-term pain relief following facet block injections. This study evaluated the concordance between two commonly used outcomes for pain relief: the pain numerical rating scale (NRS) and the global perceived improvement (GPI) scale. DESIGN: This is a retrospective cohort study. METHODS: Data were obtained from a consecutive cohort of patients through a review of the electronic medical records, with the following inclusion criteria: medial branch facet blocks at either cervical or lumbar spinal regions...
September 2012: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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