Purposes of the study and background: Diagnostic interventional procedures are often performed on patients who suffer from cervical facet joint pain and discogenic pain emanating from the cervical region. These procedures require radiographic imaging to confirm placement of instruments e.g. needles. However, these techniques are unable to provide real-time images hence prolonging the intervention. It would be of benefit to have an imaging tool that is capable of visualising needle insertion in real-time whilst preventing side effects. The purpose of this study was to determine the ultrasonic appearance of cervical facet joints in vivo and describe a standardized transducer position to visualise intervertebral discs and facet joints.

Summary of the methods and the results: 10 healthy volunteers (age range: 21–36 years, 6 females, 4 males) were evaluated using an 8-16MHz linear array transducer (Diasus Dynamic Imaging). Subjects were scanned in a prone, lateral position. The transducer was placed in the posterior triangle orientated longitudinally, initially along the posterior border of sternocleidomastoid and then moved in a cranial-caudal direction. By adjusting the angle (in the antero-posterior direction) of the transducer about a fixed position; facet joints and discs were located. The characteristic V shaped appearance of the facet joint emanates from the hyperechoic signal of the closely spaced transverse processes of adjacent vertebra (Figure1). Disc regions appeared as areas of high signal penetration into the spine with low amplitude signals returning from the disc.

Conclusion: The detail of facet joint and disc anatomy captured using ultrasound reveal it to be a viable imaging tool for interventional procedures. Noteworthy advantages of ultrasound include: its ability to provide real-time images economically, the option of portability and no known side effects.

Purposes of the study and background: This study tests the hypothesis that it is possible to visualise the cervical spine musculature using ultrasound. The use of diagnostic ultrasound is well established for assessing other anatomical regions; whereas the cervical spine has received little attention. Other available imaging procedures can be resource intensive with recognized risks and do not give an indication of structural detail. Ultrasound has the potential to resolve these inadequacies and would therefore be appealing.

Summary of the methods and the results: 10 healthy volunteers (age range: 21–36 years, 6 females, 4 males) were evaluated using a 8-16MHz linear array transducer (Diasus Dynamic Imaging, UK) and a 16MHz CL15-7 linear array scanhead transducer (Phillips ATL HDI 5000 SonoCT, Netherlands). Subjects were seated with their neck in a neutral position. The transducer was orientated transversely, and initially placed on the thyroid cartilage. Successive images were taken as the transducer was moved laterally across the anterior triangle, over the sternocleidomastoid, into the posterior triangle, ending in the posterior midline. Landmarks, with characteristic ultrasonic appearances, were identified to aid orientation e.g. carotid artery. Both machines produced images that clearly displayed the musculature of the cervical spine. Composite images were obtained of the anterior and posterior aspects of the neck (Figure 1) to provide information regarding the spatial orientation and relationship between the muscles.

Conclusion: This study concludes that modern ultrasound equipment provides cervical spine soft tissue images of a quality suitable for diagnostic applications. It also has the advantages of being a risk free, economic and portable procedure.