Place the patient in the supine position. Palpate the posterior lateral border of the cervical spine. Using a marking pen, mark the posterior border of the transverse process.

Under fluoroscopy, find the target neural foramen using a 30° oblique fluoroscopic view and place a pointer over the target site. Mark the level on the previously placed line, outlining the posterior border of the transverse process which will be the entry site for the introducer cannula.

After infiltration of local anesthetic at the needle entry site, place the C-arm in an A/P position. Advance the introducer needle to the target site at the lateral (arrow) border of the transverse process until bony contact is encountered.

Remove the metal needle of the introducer. Maintain an A/P C-arm position and introduce the Coudé® Blunt needle through the blue hub with the arrows of the needle tip facing posterior. Advance the blunt needle until you experience bony contact on the lateral border of the transverse process.

(A) Rotate the C-arm to the 30° oblique view from horizontal. Rotate the Coudé® Blunt needle 180° to the anterior position, having the arrows of the hub readily visible. (B) Advance the needle tip until it is visible in the neural foramen.

(A) Rotate the Coudé® Blunt needle back to 180° to a posterior direction and advance allowing for the needle to slide on a bone behind the nerve root. Rotate the C-arm to the A/P position. (B) On the A/P view, advance the needle to mid facet position. First aspirate, then inject contrast to verify the absence on the intravascular injection. Once this has been verified, the local/steroid of choice is injected.
*Please refer to current literature for volumes and medications used for injections.
