title: Ultrasound-Guided Cervical Facet Joint Injections: A Viable Substitution for Fluoroscopy-Guided Injections?
abstract: OBJECTIVE
  To evaluate the feasibility of ultrasound (US)-guided cervical facet injections and to identify the potential obstacles to routine use of this technique.
  
  
  METHODS
  After Institutional Review Board approval, 4 cadavers were used in this study. Age, sex, body mass index, and neck circumference were recorded. A total of 40 facet injections were performed from C2-C3 to C6-C7 under US guidance with radiodense colored latex. Visibility of cervical tissues and the needle was graded as complete, partial, or null (no injection was performed in this case). Frontal and lateral radiographs were taken, followed by cadaveric dissection to assess contrast and the latex distribution, which were recorded as intra-articular (success), peri-articular (success), or absent (failure). A 2-tailed Fisher exact test and Pearson χ(2)test were used to evaluate difference between success and failure rates for qualitative variables.
  
  
  RESULTS
  Seventy-eight percent (31 of 40) of US-guided facet joint injections were successful. No statistically significant differences were found regarding body mass index, neck circumference, needle caliber, operators, and between left and right sides. All failures involved C2-C3 and C6-C7 levels, and this result was statistically significant (Pearson χ(2) = 20.645; P < .001).
  
  
  CONCLUSIONS
  Although US-guided cervical facet joint injections are feasible, substantial obstacles may prevent their routine use. The main obstacle is to effectively identify and target the correct cervical level in a prone position.
authors.affiliation: Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada cyb_freire@yahoo.com.
authors.forename: Veronique
authors.initials: V
authors.lastname: Freire
authors.affiliation: Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
authors.forename: Detlev
authors.initials: D
authors.lastname: Grabs
authors.affiliation: Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Lepage-Saucier
authors.affiliation: Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Moser
mesh_terms: D000368:Aged; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D018084:Ultrasonography, Interventional / Q000379:methods*; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging*
keywords: cervical facet joint; facet joint injection; musculoskeletal ultrasound; ultrasound