Cervical facet injections dosing

[deleted875186]

Curious what dose and what steroid people are doing with cervical IA facet steroid injections? Do people do bilateral cervical facets? Do you guys typically use contrast?

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[MD87]

I’ve started doing more of these lately (still only 5-10/year) because I’ve inherited some patients who swear that they give them great relief for >3 months, though soon insurance may stop covering them I guess.

I do them prone, inject 0.1-0.2cc contrast. Max 0.5cc dex or when my syringe meets some resistance, indicating joint is at capacity, usually felt at about 0.3cc of dex or not felt at all.

 

[RoloTomassi]

0.5-1.0 ml dex 10mg/ml. Yes contrast, 0.1-2 ml

 

[deleted875186]

Interesting, are most people using dex? Are people using depo?

So if you did two or three facet joints, people are injecting 5 mg or so of dex in each joint? Do people use local in cervical facet joints?

 

[RoloTomassi]

Yes about 5 mg dex per joint if multiple. Handful of vascular when clearly in joint. Sometimes mix with local.

 

[Ferrismonk]

I stopped doing them and now only do MBB/RF, but I only used dex due to high vascularity in the c-spine. 1/4% Bupi as a carrier for the steroid. Minimal volumes per joint, about 1/2cc in and perhaps 1/2cc immediately posterior.

 

[clubdeac]

I do these frequently. Use 40mg depo per side and typically split it b/w 2-3 joints. I also use 0.25% marcaine as my carrier. Just the other day I had some epidural spread during an injection which made me a little nervous even though that combo in the epidural space would theoretically be fine.

 

[chibadriver]

Mostly MBBs now, but similar to others: 0.1-0.2 contrast and 0.5 of a solution of 20mg dex (2mL) and 1mL 1% lidocaine. I try to get away with three levels each side if I can, usually C2/3 to C4/5 for the headache with neck pain crowd. They do so well with RFA I usually try to steer them this direction but there are those who’ve had great luck with z-joints and only come around every 6 months to a year. Can’t argue with results.

 

[painfree23]

Mostly MBBs now, but similar to others: 0.1-0.2 contrast and 0.5 of a solution of 20mg dex (2mL) and 1mL 1% lidocaine. I try to get away with three levels each side if I can, usually C2/3 to C4/5 for the headache with neck pain crowd. They do so well with RFA I usually try to steer them this direction but there are those who’ve had great luck with z-joints and only come around every 6 months to a year. Can’t argue with results.

Do you always do C2-C4 despite what MRI shows? Used to do C2-C5, but new rules only allow billing for 2 joints

 

[chibadriver]

Do you always do C2-C4 despite what MRI shows? Used to do C2-C5, but new rules only allow billing for 2 joints

I haven’t had any trouble getting authorization for repeat three level, if I’m PA’ing a new two level, I’ll authorize TON and C4-5 and place the needles as usual for three levels… I usually bipolar the TON anyway (A practice I’ve adopted as a result of this forum), and the caudal most needle is easily repositioned at C3 MB, if not there already. Otherwise: 20 ga, 10 mm active tip, one or two passes, 0.5-0.75 mL 2% lidocaine and burn right away.