Purpose: Cervical foraminal injection performed with a direct foraminal
approach may induce serious neurologic complications. We describe a
technique of CT-guided cervical facet joint (CFJ) injection as an indirect
foraminal injection, including feasibility and diffusion pathways of the
contrast agent.
Methods and materials: Retrospective study included 84 punctures
in 65 consecutive patients presenting neck pain and/or radiculopathy
related to osteoarthritis or soft disc herniation. CT images were
obtained from C2 to T1 in supine position, with a metallic landmark on
the skin. CFJ punctures were performed by MSK senior radiologists with
a lateral approach. CT control of the CFJ opacification was performed
after injections of contrast agent (1 ml), followed by slow-acting
corticosteroid (25 mg). CFJ opacification was considered as successful
when joint space and/or capsular recess opacification occurred.
The diffusion of contrast agent in foraminal and epidural spaces was
recorded. We assessed the epidural diffusion both on axial and sagittal
images, with a classification in two groups (small diffusion or large
diffusion).
Results: CFJ opacification was successful in 82% (69/84). An epidural
and/or foraminal opacification was obtained in 74% (51/69). A foraminal
opacification occurred in 92% (47/51) and an epidural opacification in
63% (32/51), with small diffusion in 47% (15/32) and large diffusion in
53% (17/32). No complication occurred.
Conclusion: CT- guided CFJ injection is easy to perform and safe.
It is most often successful, with a frequent epidural and/or foraminal
diffusion of the contrast agent. This technique could be an interesting
and safe alternative to foraminal cervical injection.