Accuracy of Ultrasound-guided Nerve Blocks of the Cervical Zygapophysial Joints

Background: Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. Methods: Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement K, and chance-independent agreement Phi between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. Results: One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), K was 0.74 (0.64-0.83), and Phi 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. Conclusions: Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.