Fluoroscopic Findings of Extra-Cervical Facet Joint Flow and Its Incidence on Cervical Facet Joint Arthrograms

Abstract

Cervical facet joint (CFJ) syndrome is a common cause of neck pain. For its diagnosis and treatment, CFJ injection with arthrogram is generally performed. This study aimed to investigate the frequency of extra-CFJ flow on CFJ arthrograms during injections and its differences according to age, sex, and cervical vertebral level. We analyzed 760 CFJ arthrograms administrated to 208 patients diagnosed with CFJ syndrome. Arthrograms at each vertebral level were collected to evaluate the normal CFJ and extra-CFJ flow. The primary and secondary outcomes were frequency of extra-CFJ flow according to cervical vertebral level, age, and sex and according to pairwise cervical levels, respectively. Extra-CFJ flow at the cervical spine occurred during 179 injections, and the overall incidence was 3.3–36.2% at different cervical levels. The incidence of extra-CFJ flow at each cervical vertebral level according to age and sex was not significant. Extra-CFJ flow was the highest at C6 and C7, but there was no statistical significance. Extra-CFJ flow was higher at lower vertebral levels (C5–C7) than at upper levels (C3 and C4). Additional clinical studies and anatomical evaluations are needed to support its clinical value and enable the development of new injection techniques.

Facet Joint Versus Transforaminal Epidural Steroid Injections in Patients With Cervical Radicular Pain due to Foraminal Stenosis: A Retrospective Comparative Study

“…Its articular capsules are generally thin and loose, but they seem longer, looser, and thinner in the cervical region. 33 Although the previous RCT 6 and our study suggest that FJ steroid injection can be a valid and safe alternative to TFE steroid injection in patients with cervical radicular pain, FJ steroid injection may cause iatrogenic damage to the FJ capsule. 34 Therefore, incorporating the FJ steroid injection in patients with cervical radicular pain should be at the physician’s discretion.…”

“…Kelekis et al 13 demonstrated an efficacious, feasible, and indirect cervical nerve root injection technique: puncture of the facet joint capsule with subsequent distribution of the corticosteroid intraarticularly, periradicularly, and within the epidural space. Won et al 33 mentioned that extra-FJ flow, including epidural leakage, showed high frequency at the lower cervical vertebrae, where there are many strains of capsular ligaments subject to peak FJ compression due to sliding.…”

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

“…Several studies have sought to determine the specificity of IA cervical facet injections. In an observational study examining the accuracy of 760 fluoroscopically-guided IA injections performed in 208 patients using 0.2 mL of contrast administered through a 25-gauge needle, Won et al [ 225 ] found that joint overflow occurred in 23.6% of injections, being highest at C5–6 (36.2%) and lowest at C3–4 (3.3%). In a retrospective study evaluating the spread patterns of 29 patients who underwent a single CT-fluoroscopy-guided cervical IA facet injection performed with 0.5–1 mL of contrast and 1 mL of steroid, Bureau et al [ 224 ] reported IA and retrodural spread in 62% of injections, IA and epidural spread in 7%, and extra-articular spread without IA contrast was observed in 21% of injections.…”

Necessity of an exact anatomical understanding for the better pain practice

“…Moreover, the unprecedented development and progress in the management of pain, specifically utilizing these interventional techniques, heralded the evolution of interventional pain management cited by or through the Korean Journal of Pain (KJP). Of particular interest are researches that re-examine the anatomical structures that may be meaningful in relation to the cause of pain or its treatment [ 2 - 5 ].…”

“…The authors, each with more than 20 years of experience in the field of pain medicine or human anatomy, discovered interesting facts in their conversation [ 4 ]. They found differences in the perceptions of the clinical significance of a particular anatomical structure, and came to the conclusion that these differences were more common than they had previously thought.…”