Figure 188

Cervical C1-C2 Z joint block, lateral view.

Indications The ZJ block is used in the workup of chronic low back pain or in case of concomitant radiographic picture of pathology at the spinal nerve level and of the ZJ with a nonclassic radicular-type pain distribution. At times, joint aspiration can shed light on unexpected pathology, such as crystal arthropathy.

Procedure Under fluoroscopy the Z joint is accessed by a 25-gage needle, and 0.3 mL of contrast is injected to visualize an arthro-gram. Generally 0.5 to 1 mL of local anesthetic is then injected, and the patient is instructed to fill out a temporal pain diagram.

The ZJ block can be performed at the cervical (Figures 18-7 and 18-8), thoracic, and lumbar (Figure 18-9) levels.

Medial Branch (MB) Nerve Block

An anesthetic solution injected near these nerves will block the pain transmission from the respective ZJ.

Indications Indications for the MB nerve block are the same as for the ZJ block. The MB nerve block is used when it is technically difficult to access the Z joint. As each Z joint is innervated by two medial branch (MB) nerves; both nerves must be blocked to have an effective diagnostic block of the Z joint.

Procedure Because of the close proximity of the MB nerves to the spinal nerves, only a small amount of anesthetic (0.25 to 0.5 mL) is to be deposited on each nerve to avoid spillover on the spinal nerve. It is important to first inject 0.1 to 0.2 mL of contrast material to make sure the needle tip is not intravascular or close to the spinal nerve.

Under fluoroscopy the needle tip is being advanced to the groove at the junction of the superior articular process (SAP) and the transverse process (TP) at the intermamillary ligament area. Block of the MB nerves can be done at the cervical and lumbar (Figures 18-10 and 18-11) levels.

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