Background and indications: Ultrasound-guided cervical transforaminal injections have been described by Galiano et al.¹ who performed the first cadavEric study. The technique has been criticized due to the potential risk of spinal cord injury and intravascular (radicular artery) injection with the ventrodorsal oblique approach. Narouze et al.² studied ultrasound-guided cervical nerve root injections with confirmatory fluoroscopy. In this study, the target was the posterior aspect of the neural foramen, anterior to the superior articular process, as seen in the oblique view. Using this technique, he was able to demonstrate needle placement within 3 mm of the target in all patients in the lateral oblique view and within 8 mm in the anterior-posterior (AP) view. Because cervical foramina are oriented obliquely ventrally but the needle is inserted obliquely dorsally, a proper transforaminal spread may not always be possible, and this method should be rather named as the ultrasound-guided selective nerve root injection. Nevertheless, it may be actually preferential practice when a diagnostic analgesic blockade is indicated in the case of cervical radiculopathy.

Anatomy: Anatomy is as described previously. The Chassaignac tubercle is the most prominent bony protuberance of the C6 transverse process, and it is readily palpable on the anterior neck. An axial image at this location will show the typical appearance of the anterior and posterior tubercles with the exiting nerve root in between. Identification of the remaining exiting nerves can be performed by scanning caudad, for C7, and cephalad for nerve roots C3-C5. A color Doppler should routinely be used to localize radicular arteries and to avoid vascular injury.

Patient position: Lateral decubitus with head placed on the pillow and the upper shoulder rotated backward to allow better access to the lateral neck.