For cervical spine z-joint injections, the approach may be posterior, lateral, or by using a pillar-type projection (10,20). The patient is positioned decubitus or supine with the head
FIGURE 6 Cervical zygapophyseal joint injection lateral approach: For the C3-C6 level a lateral projection is obtained profiling the joint margins. Under fluoroscopy the mid-point of the joint is targeted (arrow).
turned away from the affected side. These injections are best performed under C-arm fluoroscopy. At the C2-C3 level the z-joint slopes inferiorly at its posterior and medial aspect; therefore particular or specialized projections are used. One option is to rotate the X-ray tube cephalad until the joint is profiled. Another option is to rotate the X-ray tube to the patient's rear (posteriorly), to bring the posterolateral aspect of the joint into profile. For the C3-C6 levels, a lateral approach is advocated (Fig. 6). The target zone is the mid-portion of the joint along its lateral margin. If the X-ray tube is rotated close to a true lateral, this will profile the joint margins. The left and right joints might be nearly superimposed and slight rotation of the C-arm may be performed to determine which is the appropriate side (e.g., closest). However, if truly superimposed, then the targeting should be similar despite the side and not be problematic. The volume of contrast injected is typically 0.1 to 0.3 mL, so as not to rupture the joint capsule prior to anesthetic/corticosteriod administration (Fig. 7).
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