US-Guided Interventions Cervical Spine Injections

Application of ultrasound (US) in pain medicine is a rapidly growing field of interventional pain management and in the recent few years US guidance for spine injections in chronic pain practice has been noticed. The cervical spine is supposed to be a better place to start than the lumbar spine, as US may be more advantageous in the neck for the identification of various critical soft tissue structures, thus making the injection easier and safer. In the present report, we review the known US-guided cervical spine procedures briefly. Sonoanatomy of the Cervical Spine for Wellknown Cervical Spine Interventions Identifying the correct cervical spine level [1] Lower cervical spine procedures: 1. The ultrasound probe is initially placed at the level of the Introduction Ultrasound (US)-guided pain blocks has grown up since 2004 from lumbar and cervical facet nerve blocks (cervical medial branch block, C-MBB) and intra-articular injections [1-3]. This was followed by a renewed interest in US-guided stellate ganglion block [4] and then by rapidly growing interest in the application of US for cervical spine in pain medicine such as cervical nerve root block [5], and recently deep cervical plexus block [6] and atlantoaxial (AA) joint injection [7]. It must be true that the cervical spine is a better place to start than the lumbar spine, as US may be more advantageous in the neck for the identification of various critical soft tissue structures, thus making the injection easier and safer. It is well known US-guidance appealing for a few points [1,8]: 1) radiation-free imaging. This is especially important with cervical injections. Where there is increased scattered radiation from the c-arm; 2) ability to identify and avoid vessels in the trajectory of the needle; 3) US offers dynamic, real-time imaging of the cervical spine; and 4) Short procedure time and the need to insert only 1 needle (for third occipital nerve blocks). Recently, in accordance with the remarkable increase in the publication of literatures and the growing number of workshops on US-guided injections, the Joint Committee (ASRA/ESRA/Asian Australasian Federation of Pain Societies and committee members) published a recommendations and training guidelines to provide a structure about proper levels of competency, proficiency, and quality improvement for the safe and the efficacious utilization of US for pain medicine procedures [9]. The Joint Committee assigned level of difficulty for specific US-guided pain interventions –US-guided cervical spine interventions usually belong to the intermediate or advanced level of difficulty. In the present article, we reviewed the known US-guided cervical spine procedures briefly. Review Article US-Guided Interventions Cervical Spine Injections JeeYoun Moon1,2,*, Sang Chul Lee1 1Anesthesiology & Pain Medicine, Seoul National University Hospital, Korea 2Integrated Cancer Pain Management Center, Seoul National University Cancer Hospital, Korea *Corresponding author: JeeYoun Moon, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 110 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea Received: December 02, 2013; Accepted: January 24, 2014; Published: January 27, 2014 Figure 1 (A) Short-axis transverse US image showing the sharp anterior tubercle (AT) of the C6 TP (transverse process). C6 & C5 indicated each nerve root; CA, carotid artery; PT, posterior tubercle; Eso, esophagus; Th, thyroid gland; Lco, longus coli muscle; ASc, anterior scalene muscle; MSc, middle scalene muscle. (B) Cross-sectional MRI image related to the transverse US image. Austin Publishing Group A