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Paraspinal Injections - Facet Joint and Nerve Root Blocks: Multimedia
Updated: May 6, 2009
Multimedia
 | Media file 1: Image obtained with the correct obliquity demonstrates the posterior opening of the facet joint as 2 dark parallel lines (arrows). Ideally, the needle tip is placed along the medial line and maneuvered into the joint space. Note that this particular joint is narrowed. |
 | Media file 2: Image obtained with a steeper obliquity at a different level than seen in Image 3 (in Multimedia) demonstrates a facet joint that appears widely patent. However, the angle is too steep, and what is actually shown is the anterior-medial opening. An attempt to place a needle into the joint at this angle would be unsuccessful. |
 | Media file 3: Oblique image demonstrates needles placed into severely degenerated facet joints at L4-5 and L5-S1. Note the medial turn that the needles take to show that they are within the joint itself. |
 | Media file 4: Cervical facet injection at C7-T1 shows the needles within the joints on each side. Unlike the upper cervical facet joints, this level can be accessed with only slight angulation. |
 | Media file 5: Anteroposterior (AP) view from a selective nerve root block (SNRB) study shows appropriate placement of the needle tip in the superior portion of the foramen. The needle should not be medial to the midpoint of the pedicle. |
 | Media file 6: Lateral view shows the needle in the superior portion of the foramen, a position that helps prevent direct neural puncture. |
 | Media file 7: After an injection of contrast material, the nerve is outlined, but no vascular or nerve-sleeve opacification is demonstrated. |
 | Media file 8: Image from a fluoroscopic-guided nerve root block procedure. Note the contrast material flowing around the nerve root sleeve, indicating proper needle positioning. Courtesy of Phil Landers, MD, The Montreal General Hospital, McGill University Health Centre, Quebec, Canada. |
 | Media file 9: CT scan from a scout series prior to a lumbar nerve root block. Note the marker, which allows accurate measurements to determine the optimal site for skin puncture (lines). The right nerve root is seen in the outer aspect of the neural foramen (arrow). |
 | Media file 10: CT fluoroscopic image (same patient as in Image 1 in Multimedia) demonstrates that the tip of the needle is in a good position in the outer aspect of the neural foramen. The image is grainy because of the low milliampere setting used in CT fluoroscopy. |
 | Media file 11: CT fluoroscopic image from a thoracic nerve root block study demonstrates the needle tip in the outer aspect of the neural foramen. Thoracic nerve root blocks can be more difficult than lumbar or cervical blocks because the ribs can obstruct a clear path to the neural foramen, particularly in patients with scoliosis. |
 | Media file 12: Contrast material should flow around the nerve root when needle placement is checked. This finding confirms that the needle is not within a vessel or the nerve root sleeve. Note that the needle is in the posterior portion of the outer neural foramen |
 | Media file 13: CT fluoroscopic image from a cervical nerve root block demonstrates the appropriate needle path and the placement of the needle tip in the lower aspect of the neural foramen. A lateral approach avoids the carotid and jugular vessels and, as in this case, often can prevent puncture of the sternocleidomastoid muscle. |
 | Media file 14: The injection of a small amount of contrast material under the guidance of a few seconds of CT fluoroscopy can be used to confirm the extravascular location of the needle. |
More on Paraspinal Injections - Facet Joint and Nerve Root Blocks |
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| Further Reading |
References
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Further Reading
eMedicine Related topics
Local Anesthesia and Regional Nerve Block Anesthesia
Therapeutic Injections for Pain Management
Regional Anesthesia For Postoperative Pain Control
Clinical trials
Effectiveness of Lumbar Facet Joint Nerve Blocks
Effectiveness of Thoracic Facet Joint Nerve Blocks
The Specificity of Cervical Facet Medial Branch Blocks
Guidelines
Coding of Diagnostic and Therapeutic Spinal Procedures
Keywords
paraspinal injection, facet joint block, nerve root block, facet block, zygapophyseal joint block, parafacet block, facet joint injection, facet-joint injection, spinal nerve root injection, transforaminal epidural injection, selective nerve root blocks, SNRBs, lumbar facet pain, facet syndrome
