Spinal injection of local anesthetic during cervical facet joint injection

Ramos, Jonathan Hernández

doi:10.1016/j.bjane.2014.04.004

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Ін'єкції у фасеточні суглоби -поширений та безпечний метод лікування болю в спині при фасеточній артропатії. У США даний спосіб інтервенції займає 2-ге місце серед усіх втру-чань, що виконуються для зняття болю [23]. Як інтер-венційні процедури вони відрізняються дуже малим ризиком розвитку ускладнень, включно з інфекційни-ми, пошкодженням нервових стовбурів.…”

Section: âñòóïunclassified

Результати Лікування Хворих Із Нижньопоперековим Больовим Синдромом, Де Домінували Прояви Спондилоартрозу, Із Використанням Радіочастотної Денервації Фасеточних Суглобів У Поєднанні З Періартикулярним Введенням Місцевих Анестетиків Та Стероїдних Препараті

Kvasnitskyi¹

2022

TRAUMA

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Результати Лікування Хворих Із Нижньопоперековим Больовим Синдромом, Де Домінували Прояви Спондилоартрозу, Із Використанням Радіочастотної Денервації Фасеточних Суглобів У Поєднанні З Періартикулярним Введенням Місцевих Анестетиків Та Стероїдних Препараті

Kvasnitskyi¹

2022

TRAUMA

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“…Subarachnoid injection of LA has also been described following a fluoroscopically-guided IA injection of the C6–7 facet joint in a patient with a prior anterior fusion. 373 A non-image-guided injection of 4 mL LA into the C5–6 facet joint resulted in transient tetraplegia that lasted 30 min. The authors postulated that the LA was injected into a radicular artery feeding into the anterior spinal artery at that level.…”

Section: Question 18: What Are the Most Common Complications Of Cervical Facet Interventions And How Can They Be Minimized?mentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Hurley

Adams

Barad

et al. 2021

Reg Anesth Pain Med

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BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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“…Although no such complications associated with cervical facet procedures have been reported in the liaterature, a case report described new sensory symptoms in the dermatomal distribution of the fifth lumbar nerve following RFA of the third to fifth lumbar medial branches and dorsal rami [ 330 ] Sensory and motor stimulation to reduce the probability of proximity of the RF cannula tip to the spinal nerve root traversing the foramen has been advocated to prevent injury to spinal nerves, but the evidence is inconclusive. Subarachnoid injection of LA has also been described following a fluoroscopically-guided IA injection of the C6–7 facet joint in a patient with a prior anterior fusion [ 373 ] A non-image-guided injection of 4 mL LA into the C5–6 facet joint resulted in transient tetraplegia that lasted 30 min. The authors postulated that the LA was injected into a radicular artery feeding into the anterior spinal artery at that level [ 127 ] Although the use of US may reduce the incidence of vascular penetration, injury to neural structures may occur with misplaced needles (irrespective of the imaging modality) as evidenced by a case of spinal cord injury during a cervical MBB at C7 [ 148 ].…”

Section: Question 18: What Are the Most Common Complications Of Cervical Facet Interventions And How Can They Be Minimized?mentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

et al. 2021

View full text Add to dashboard Cite

Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored b...

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Spinal injection of local anesthetic during cervical facet joint injection

Cited by 3 publications

References 9 publications

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

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