Ultrasound-Guided Thoracic Facet Injections

Stulc, Steven M.; Hurdle, Mark Friedrich B.; Pingree, Matthew J.; Brault, Jeffrey S.; Porter, Christopher A.

doi:10.7863/jum.2011.30.3.357

Cited by 18 publications

(16 citation statements)

References 13 publications

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“…US-guided thoracic facet injections have been described by Stulc et al [33] . Using fluoroscopy 3D reconstruction imaging, this cadaveric study showed an 80% success rate of the US-guided procedures.…”

Section: Review Gofeld and Montgomerymentioning

confidence: 99%

Spine Ultrasonography: Interventions and Diagnostics

Montgomery

2012

Pain Manage.

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SUMMARY Ultrasound-guided procedures are well established and utilized in the regional anesthesia and radiology practice. Conversely, there have been considerable difficulties in implementation of ultrasound in pain medicine. Ultrasonography has to compete with the more established modalities such as fluoroscopy and computed tomography; however, ultrasound has the advantage of radiation safety and point-of care imaging. It also allows direct visualization of tissue planes, blood vessels and nerves. Ultrasound-guided spine interventions are technically feasible and reasonably accurate when validated with conventional radiological modalities. Epidural, zygapophysial joint and caudal injection techniques have been published. The main pitfall of the ultrasound-guided spinal procedures lies in the inability to diagnose intravascular injections. Future technological improvements will help to solve this problem. Diagnostic spinal sonography may also contribute to the practice of medicine helping in the clinical workup of scoliosis and paraspinal pathology.

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Section: Review Gofeld and Montgomerymentioning

confidence: 99%

Spine Ultrasonography: Interventions and Diagnostics

Montgomery

2012

Pain Manage.

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“…Ultrasound-guided interventional pain procedures have been described for cervical, thoracic, and lumbar facets [36][37][38]. Galiano et al [39] has shown that ultrasoundguided lumbar facet injections were both safe and effective with decreased procedure time and no ionizing radiation exposure for the patient or practitioner and Yun et al [40] demonstrated that the efficacy of ultrasound-guided lumbar facet injections was equal to that of fluoroscopic injections for pain control and return to activities of daily living.…”

Section: Pain Medicinementioning

confidence: 99%

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Deimel

Jelsing

Hall

2013

Curr Phys Med Rehabil Rep

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“…On physical examination, patients may experience tenderness with palpation over the affected joint; this pain is exaggerated by spine extension, waxes and wanes with physical activity and is often worse at the end of the day [17]. Definitive diagnosis is made by performing an intra-articular injection of local anesthetic or by selectively anesthetizing the medial branch of the dorsal ramus of the spinal nerves corresponding to the level of the patient's pain [18]. In the past, diagnostic intra-articular injections and medial branch blocks were considered equivalent [17].…”

Section: Organization Of the Reviewmentioning

confidence: 99%

“…Thoracic facets are localized by first identifying T12; after, the vertebral bodies are counted moving cephalad until the joint of interest is identified [18]. Feasibility studies have shown some promise but currently, there are no prospective randomized studies that compare US-guided thoracic facet or medial branch blocks to tr aditional approaches such as CT or FS [18].…”

Section: Thoracic Facet Jointsmentioning

confidence: 99%

“…By employing an in-plane approach, the provider can advance the needle into the joint space under direct visualization. Poor visibility of the facet joints with US (in obese or physically disabled patients) and acoustic shadowing artifact makes it impossible to locate the needle tip once it has entered the area of the joint capsule deep to bone [17,18].…”

Section: Organization Of the Reviewmentioning

confidence: 99%

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Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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Ultrasound-Guided Thoracic Facet Injections

Abstract: We describe a relatively feasible technique for performing thoracic facet joint injections using ultrasound guidance. Further verification of this technique, and modification if applicable, should be performed before directly applying this technique in a clinical practice setting.

Cited by 18 publications

References 13 publications

Spine Ultrasonography: Interventions and Diagnostics

Spine Ultrasonography: Interventions and Diagnostics

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

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