1. 2025;28;E199-E203Technical Modification of Cervical Facet Joint Radiofrequency Ablation: A Novel Approach
   Current Opinion
   Boqing Chen, MD, PhD, Daniel H. Cho, BS, Kevin W. Tang, BS, Malaka Badri, DO, Patrick M. Foye, MD, and Todd P. Stitik, MD.

BACKGROUND: Current standards of practice recommend performing the cervical medial branch block (MBB) and applying the subsequent radiofrequency ablation (RFA) electrode via anterior-posterior (AP) and lateral fluoroscopic views. The lateral views of the lower cervical segment are frequently hindered by patients’ anatomical factors and prevent the accurate and safe placement of the RFA needle.

OBJECTIVE: The goal of this technical modification is to introduce and standardize an oblique angle view using fluoroscopy to enable more accurate placement of the MBB needle and RFA needle electrode in the cervical facet joint.

STUDY DESIGN: The technical modification was developed using a cadaveric skeletal model. Then, in an actual patient, this additional oblique view was tested in an RFA procedure for a cervical facet joint.

SETTING: This protocol was produced at a single musculoskeletal and interventional spine center.

METHODS: A team of interventional pain specialists developed a step-by-step technique that utilized a 50-degree ipsilateral fluoroscopic view, in addition to AP and lateral views, by simulating a cervical facet joint RFA in a cadaveric skeletal model. The technique was then tested in an actual patient’s cervical facet joint RFA procedure.

RESULTS: The team successfully developed a technique to confirm placement of the RFA needle electrode at the articular pillar to denervate the medial branch for treating pain in the cervical facet joint. This technique allows for the clear visualization of the needle RFA electrode to overcome patient factors that can obscure the electrode, including physiological aspects such as short neck and shoulder musculature.

LIMITATIONS: A potential disadvantage of this technical modification is the additional radiation exposure, which is caused by the addition of an oblique view.

CONCLUSIONS: Our technical modification of an oblique angle view enables clear visualization, thus increasing the accuracy and potentially the safety of RFA needle electrode placement in lower cervical facet joint RFA over those of the conventional approach.

KEY WORDS: Cervical facet joint pain, radiofrequency ablation, medial branch block