Cervical Facet Plane Block: The When, How, on Whom

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ultrasound cervical facet joint
Cervical facet plane block has been successfully used in the treatment of cervicalgia and cervical facet arthropathy.

 

The cervical facet plane block is a procedure in which a needle is inserted onto the extraarticular surface of the facet joints.

 

On the longitudinal ultrasound view, the cervical spine facet joints appear as a row of shingles and are therefore easy to visualize and access with an in-plane approach using a 25-gauge spinal needle.

 

Cervical facet plane block is helpful in treating cervicalgia and facet arthropathy.

 

Once the needle is visualized on the extraarticulate surface and local anesthetics (with or without steroid) are injected, spread of the anesthetic can be seen caudad and cephalad to the insertion point along the facet line. Although this procedure description is based on anecdotal reports, it has been used successfully in the treatment of cervicalgia and cervical facet arthropathy.

 

Advantages to this technique revolve around the ability to get multilevel spread with only one needle stick. This technique may be optimal when considering facet injections in a patient who needs to continue on anticoagulant medication and is in great need of the procedure. Significant bleeding may occur, and therefore caution is advised—use clinical judgment. Only those experienced with ultrasound and with expertise to avoid blood vessels should attempt the procedure.

 

Disadvantages to the technique include risk for vasovagal reaction, which is seen in cervical facet injections more often than in cervical medial branch blocks. Another disadvantage is that the needle is not actually entering the facet joint and therefore the anti-inflammatory drug may not reach its target tissues. That being said, the technique appears to be quite efficacious in treating pain related to the facet joint.

 

There is no official Current Procedural Terminology code for this procedure. Consider using this block in cases in which a patient is taking an anticoagulant that should not be discontinued and for whom the benefit of cervical facet injection outweighs the risk of stopping the anticoagulant or not treating the cervicalgia or facet arthropathy.

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