Uncovertebral Joint Block

[Aether2000]

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Food for thought and with a warning not to try this before the appropriate approach has been worked out. I did my first C4/5 uncovertebral joint block from an anterior approach recently in a female 35 year old patient with cervical pain unresponsive to MBB. She has uncovertebral hypertrophy. After the injection of 0.3cc bupivicaine/depomedrol mixture, she has had 50% relief or more in the cervical area for 14 days now. I will keep you posted on this interesting block that has the potential to address the site of significant arthropathy.

 

[bedrock]

Interesting- Let us know how they're doing in a month or two.

 

[knoxdoc]

I've always wondered if that joint was a potential generator of significant pain. I haven't heard much about it at all. Nice work!

 

[SleepIsGood]

Food for thought and with a warning not to try this before the appropriate approach has been worked out. I did my first C4/5 uncovertebral joint block from an anterior approach recently in a female 35 year old patient with cervical pain unresponsive to MBB. She has uncovertebral hypertrophy. After the injection of 0.3cc bupivicaine/depomedrol mixture, she has had 50% relief or more in the cervical area for 14 days now. I will keep you posted on this interesting block that has the potential to address the site of significant arthropathy.

yah sounds rare. interesting enough to be a case report?

 

[Aether2000]

Possibly a case report...good idea. Bear with me on the logic here and chime in with your thoughts.
The uncovertebral joint is frequently involved in hypertrophic compression arthrosis with hypertrophy of the joint not uncommonly leading to foraminal stenosis. When the lumbar disc space collapses in DDD, the biomechanical shift of weight first transfers to the annulus fibrosis, then after annular degeneration transfers load to the z-joints. The resultant hypertrophy leads to arthropathy of the joints plus foraminal stenosis. However in the cervical spine, the z-joints are not the ultimate load bearing structure: the uncovertebral joint bears the load after cervical disc degeneration. This explains why the cervical facet joints rarely hypertrophy and almost never cause cervical foraminal stenosis. The load bearing equivalent to the lumbar z-joint is the cervical uncovertebral joint, and may be subject to the same painful arthropathies, albeit with somewhat different intra-articular cartilage and synovium constructs. The innervation to the joint is ???? Possibly sympathetic from the nearby sympathetic chain, but what about somatic? Is there any anterior somatic equivalent to the medial branch?

 

[Ligament]

Food for thought and with a warning not to try this before the appropriate approach has been worked out. I did my first C4/5 uncovertebral joint block from an anterior approach recently in a female 35 year old patient with cervical pain unresponsive to MBB. She has uncovertebral hypertrophy. After the injection of 0.3cc bupivicaine/depomedrol mixture, she has had 50% relief or more in the cervical area for 14 days now. I will keep you posted on this interesting block that has the potential to address the site of significant arthropathy.

Hooray! Great Job Algos. Images Please (or email me if you don't want them public).

 

[Ligament]

I'm doing this procedure tomorrow! (kidding)

 

[Aether2000]

lol. The initial image showed anterior spread along the esophageal constructor muscle until I advanced into the midpoint of the joint....I will try to retrieve these soon from my archive files...

 

[PMR 4 MSK]

I thought the uncovertebral joint was a false joint - a non-synovial one that develops in the presence of spondylosis.

😕

 

[Aether2000]

True, but in Raushning samples, he never found facet hypertrophy causing cervical foraminal stenosis but did find uncovertebral joint spondylosis induced foraminal stenosis. So what causes selective severe spondylosis of the uncovertebral joint while sparing the cervical z-joints? The only thing I can come up with is biomechanical weight transfer to the uncovertebral joint....

 

[Tenesma]

i see Unco-vert arthrosis a lot in my older patients w/ CT scans... but is it truly a joint or just the juxtapposition of the endplates lateral to the disc?

getting to those spots will be tricky///

 

[Jcm800]

i see Unco-vert arthrosis a lot in my older patients w/ CT scans... but is it truly a joint or just the juxtapposition of the endplates lateral to the disc?

my thoughts also...not really a joint in my my brain...

 

[Aether2000]

So if not a true joint but causing pain anyway, how could we denervate it? Sympathetic denervation?

 

[Tenesma]

denervating any joint is difficult... we are lucky that facet joints have some lateral innervation, even though i really believe there is innervation to those joints that we miss...

how about injecting some form of novel silicone bubbles that can help cushion between the bones?

 

[Aether2000]

Interesting. That would perhaps avoid the development of spondylosis at the joint...

 

[hyperalgesia]

denervating any joint is difficult... we are lucky that facet joints have some lateral innervation, even though i really believe there is innervation to those joints that we miss...

I agree.

how about injecting some form of novel silicone bubbles that can help cushion between the bones?

Maybe some day. I wonder if something like the Trufuse system would have an application for uncovertebral "joints", after "intraarticular" local anesthetic demonstrably kills the pain.