Ultrasound-Guided Cervical Zygapophyseal (Facet) Intra-Articular Injection

  • Samer N. Narouze


Cervical facet joints are diarthrodial joints formed by the superior articular process of one cervical vertebra articulating with the inferior articular process of the vertebrae above at the level of the junction of the lamina and the pedicle. The angulation of the facet joint increases caudally, being about 45 degrees superior to the transverse plane at the upper cervical level to assuming a more vertical position at the upper thoracic level. The superior articular process also faces in a more posteromedial direction at the upper cervical level, and this changes to a more posterolateral position at the lower cervical level, with C6 being the most common transition level [1, 2].


Cervical facet joints Cervical Zygapophyseal Intra-Articular Injection Ultrasound guided injection 


  1. 1.
    Pal GP, Routal RV, Saggu SK. The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region. J Anat. 2001;198:431–41.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Yoganandan N, Knowles SA, Maiman DJ, Pintar FA. Anatomic study of the morphology of human cervical facet joint. Spine. 2003;28:2317–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Inami S, Kaneoka K, Hayashi K, Ochiai N. Types of synovial fold in the cervical facet joint. J Orthop Sci. 2000;5:475–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004;29:390–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Kallakuri S, Singh A, Chen C, Cavanaugh JM. Demonstration of substance P, calcitonin gene-related peptide, and protein gene product 9.5 containing nerve fibers in human cervical facet joint capsules. Spine. 2004;29:1182–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004;5:15.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine. 1995;20:20–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Hove B, Gyldensted C. Cervical analgesic facet joint arthrography. Neuroradiology. 1990;32:456–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intra-articular corticosteroids for chronic pain in the cervical zygapophysial joints. N Engl J Med. 1994;330:1047–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, Peloso P. Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine. 2008;33:S153–69.CrossRefPubMedGoogle Scholar
  11. 11.
    Barnsley L, Medial BN. Branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. 1993;18:343–50.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Galiano K, Obwegeser AA, Bodner G, Ploner F. Ultrasound-guided facet joint injections in the middle to lower cervical spine: a CT-controlled sonoanatomic study. Clin J Pain. 2006;22:538–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Galiano K, Obwegeser AA, Bale R, Harlander C, Schatzer R, Schocke M, et al. Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic pattern. Reg Anesth Pain Med. 2007;32:254–7.PubMedGoogle Scholar
  14. 14.
    Obernauer J, Galiano K, Gruber H, Bale R, Obwegeser AA, Schatzer R, Loizides A. Ultrasound-guided versus computed tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial. Med Ultrason. 2013;15:10–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Narouze SN, Provenzano DA. Sonographically guided cervical facet nerve and joint injections: why sonography? J Ultrasound Med. 2013;32:1885–96.CrossRefPubMedGoogle Scholar
  16. 16.
    Narouze S, Peng P. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy and procedures. Part II: axial structures. Reg Anesth Pain Med. 2010;35:386–96.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Samer N. Narouze
    • 1
  1. 1.Professor of Anesthesiology and Pain MedicineCenter for Pain Medicine, Western Reserve HospitalCuyahoga FallsUSA

Personalised recommendations