Comparison of medial and lateral ultrasound-guided approaches for periarticular injection of the thoracolumbar intervertebral facet joints in horses.
Authors: Cousty Matthieu, Firidolfi Charlotte, Geffroy Olivier, David Florent
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Periarticular injection of thoracolumbar facet joints represents an important therapeutic option for horses with back pain, yet optimal needle placement technique has received limited investigation. Cousty and colleagues used ultrasound guidance with the transducer perpendicular to the spine to compare medial and lateral needle approaches in four cadavers, systematically documenting needle insertion depth, repositioning requirements, and final injection location across 96 attempted injections at joints from T12-T13 to L5-L6. Both approaches proved remarkably effective: 86% of injections achieved true intraarticular placement, with 96% depositing latex within 0.5 cm of the articular margin, whilst mean insertion depth was 8.5 cm with minimal need for needle reinsertion (only 1 of 96 sites). Although nearly half the injections required needle repositioning to achieve optimal placement, this cadaveric evidence suggests ultrasound-guided periarticular injection is reliably accurate regardless of approach, which has practical implications for practitioners selecting technique based on individual patient anatomy or clinician preference rather than concerns about procedural reliability.
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Practical Takeaways
- •Both medial and lateral ultrasound-guided approaches are reliable for thoracolumbar facet joint injection in horses; choice can be based on operator preference or patient positioning
- •Expect to need needle repositioning in approximately half of cases even with ultrasound guidance—this is normal and does not indicate technique failure
- •Ultrasound guidance significantly improves accuracy of facet joint periarticular injection compared to landmark-based techniques, increasing likelihood of therapeutic effect
Key Findings
- •Ultrasound-guided periarticular injection of thoracolumbar facet joints achieved 86% intraarticular deposition with only 1 needle reinsertion required across 96 attempts
- •Both medial and lateral ultrasound-guided approaches were equally effective, with 96% of injections deposited within 0.5 cm of the articular margin
- •Mean needle insertion depth was 8.5 ± 1.1 cm, though 46% of injections required needle repositioning during the procedure
- •All injections were delivered into the multifidus muscle surrounding the facet joint regardless of approach selection