Skip to main content

Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks

  • Chapter
  • First Online:

Abstract

Cervical zygapophyseal (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 angulations of the facet joints increases caudally, being about 45° 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 more posteromedial at the upper cervical level and this changes to more posterolateral at the lower cervical level, with C6 being the most common transition level.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  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(pt 4):431–441.

    Article  PubMed  CAS  Google Scholar 

  2. Yoganandan N, Knowles SA, Maiman DJ, Pintar FA. Anatomic study of the morphology of human cervical facet joint. Spine (Phila Pa 1976). 2003;28(20):2317–2323.

    Article  Google Scholar 

  3. Inami S, Kaneoka K, Hayashi K, Ochiai N. Types of synovial fold in the cervical facet joint. J Orthop Sci. 2000;5(5):475–480.

    Article  PubMed  CAS  Google Scholar 

  4. Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine. 1982;7(4):319–330.

    Article  PubMed  CAS  Google Scholar 

  5. Teo EC, Ng HW. Evaluation of the role of ligaments, facets and disc nucleus in lower cervical spine under compression and sagittal moments using finite element method. Med Eng Phys. 2001;23(3):155–164.

    Article  PubMed  CAS  Google Scholar 

  6. Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63(2):278–282.

    Article  PubMed  CAS  Google Scholar 

  7. Zdeblick TA, Abitbol JJ, Kunz DN, McCabe RP, Garfin S. Cervical stability after sequential capsule resection. Spine (Phila Pa 1976). 1993;18(14):2005–2008.

    Article  CAS  Google Scholar 

  8. Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine (Phila Pa 1976). 2001;26(19):2095–2101.

    Article  CAS  Google Scholar 

  9. Winkelstein BA, McLendon RE, Barbir A, Myers BS. An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area. J Anat. 2001;198(pt 4):455–461.

    Article  PubMed  CAS  Google Scholar 

  10. 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 (Phila Pa 1976). 2004;29(11):1182–1186.

    Article  Google Scholar 

  11. Kettler A, Werner K, Wilke HJ. Morphological changes of cervical facet joints in elderly individuals. Eur Spine J. 2007;16(7):987–992.

    Article  PubMed  CAS  Google Scholar 

  12. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine. 1995;20(1):20–26.

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004;29(4):390–397.

    Article  PubMed  Google Scholar 

  15. Radanov BP, Sturzenegger M, Di Stefano G. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine (Baltimore). 1995;74(5):281–297.

    Article  CAS  Google Scholar 

  16. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. 1993;55(1):99–106.

    Article  PubMed  CAS  Google Scholar 

  17. Barnsley L, Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. 1993;18(6):343–350.

    PubMed  CAS  Google Scholar 

  18. Barnsley L, Lord S, Wallis B, Bogduk N. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain. 1993;9(2):124–130.

    Article  PubMed  CAS  Google Scholar 

  19. Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: zygapophysial joint blocks. Clin J Pain. 1997;13(4):285–302.

    Article  PubMed  CAS  Google Scholar 

  20. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine. 1996;21(15):1737–1745.

    Article  PubMed  CAS  Google Scholar 

  21. Sluijter ME, Koetsveld-Baart CC. Interruption of pain pathways in the treatment of the cervical syndrome. Anaesthesia. 1980;35(3):302–307.

    Article  PubMed  CAS  Google Scholar 

  22. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721–1726.

    Article  PubMed  CAS  Google Scholar 

  23. Govind J, King W, Bailey B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003;74(1):88–93.

    Article  PubMed  CAS  Google Scholar 

  24. Manchikanti L, Singh V, Falco FJ, Cash KM, Fellows B. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine. 2008;33(17):1813–1820.

    Article  PubMed  Google Scholar 

  25. Eichenberger U, Greher M, Kapral S, et al. Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology. 2006;104(2):303–308.

    Article  PubMed  Google Scholar 

  26. Martinoli C, Bianchi S, Dahmane M, Pugliese F, Bianchi-Zamorani P, Valle M. Ultrasound of tendons and nerves. Eur Radiol. 2002;12(1):44–55.

    Article  PubMed  Google Scholar 

  27. Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology. 1995;197(1):291–296.

    PubMed  CAS  Google Scholar 

  28. Gofeld M. Ultrasonography in pain medicine: a critical review. Pain Pract. 2008;8(4):226–240.

    Article  PubMed  Google Scholar 

  29. Siegenthaler A, Narouze S, Eichenberger U. Ultrasound-guided third occipital nerve and cervical medial branch nerve blocks. Tech Reg Anesth Pain Manag. 2009;13:128–132.

    Article  Google Scholar 

  30. Fishman SM, Smith H, Meleger A, Seibert JA. Radiation safety in pain medicine. Reg Anesth Pain Med. 2002;27(3):296–305.

    PubMed  Google Scholar 

  31. Lord SM, McDonald GJ, Bogduk N. Percutaneous radiofrequency neurotomy of the cervical medial branches: a validated treatment for cervical zygapophysial joint pain. Neurosurg Q. 1998;8(4):288–308.

    Article  Google Scholar 

  32. Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology. 1988;167(1):179–182.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Urs Eichenberger .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Siegenthaler, A., Eichenberger, U. (2011). Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks. In: Narouze, S. (eds) Atlas of Ultrasound-Guided Procedures in Interventional Pain Management. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1681-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1681-5_6

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1679-2

  • Online ISBN: 978-1-4419-1681-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics