Cadaveric and Ultrasonographic Validation of Needling Placement in the Cervical Multifidus Muscle

Abstract

Objective: The aim of this study was to determine if a needle is able to reach the cervical multifidus during the application of dry needling or acupuncture. Methods: Dry needling and ultrasound imaging of cervical multifidi was conducted on 5 patients (age: 32 ± 5 years) with mechanical neck pain and on 2 fresh cadavers (age: 64 ± 1 years). Dry needling was done using a needle of 40 mm in length inserted perpendicular to the skin about 1 cm lateral to the spinous process at C3-C4. The needle was advanced from a posterior to anterior direction into the cervical multifidus with a slight inferior-medial angle (approximately 10°) to reach the vertebra lamina. For the cadaveric study, the multifidus was isolated by carefully resecting the superficial posterior cervical muscles: trapezius, splenius, and semispinalis. For the ultrasonographic study, a convex transducer was placed transversely over C3-C4 after the insertion of the needle into the muscle. Results: The results of both the cadaveric and ultrasonic studies found that the needle does pierce the cervical multifidus muscle during insertion and that the tip of the needle rests properly against the vertebral laminae, thereby guarding the sensitive underlying spinal structures from damage. Conclusion: This anatomical and ultrasound imaging study supports that dry needling of the cervical multifidus could be conducted clinically. (J Manipulative Physiol Ther 2017;xx:0-6)

The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle

“…No in vivo literature exists regarding accuracy of advancing a dry needle to intended target tissue. Studies involving cadaveric preparations describe success rates of reaching target structures [3][4][5], but not error rate in terms of distance, of reaching a specific point within said target tissue. Evidence exists in the interventional radiology literature suggesting that joint injections can be performed with reasonable accuracy/specificity without imaging guidance [41], but that accuracy improves to within 2 mm when the needle injection is performed under imaging guidance with robotic assist [42][43][44].…”

“…Caution must be taken in generalizing these results to patient populations as it is theoretically possible to both reach the targeted tissue and to also, unintentionally, dry needle unintended structures resulting in possible serious adverse events observed only in vivo. More recent research on accuracy of needle placement conducted in vivo and confirmed by musculoskeletal ultrasound (MSKUS) confirms success in reaching target tissue (in this case the cervical multifidus) [5]. However, the researchers did not examine the impact of patient positioning.…”

Acute Spinal Epidural Hematoma as a Complication of Dry Needling: A Case Report

“…When comparing the 2 procedures, specifically in relation to the cervical spine, the depth of needle insertion is similar. The recommended depth for acupuncture points is no more than 33 mm in the average individual , whereas dry needling of the cervical multifidus might require up to 40 mm .…”

“…However, the literature on the area in question is scarce. Only 1 small study mentioned the use of ultrasound to identify that the needle had adequately reached the multifidus muscle . Informed consent should include the possibility of epidural hematomas and patients should be instructed to monitor for any neurologic symptoms or signs.…”

Accuracy and safety of dry needle placement in the piriformis muscle in cadavers

“…Generally, there are two approaches to access the piriformis muscle with DN surrounding neural, vascular or visceral structures. To date, only three investigations have attempted to validate DN placement in the lateral pterygoid, the lumbar multifidus, and the cervical multifidus muscles [22][23][24]. Mesa-Jiménez et al [22] validated a proposed dry needling approach to reach the lateral pterygoid, using two fresh cadaveric heads.…”