DOI: 10.1093/pm/pnad123 ISSN:

Ultrasound-Guided Costovertebral Joint Injection – Technique Description and Fluoroscopy and Computerized Tomography Combined Controlled Cadaveric Feasibility Study

Nuno Ferreira-Silva, Lucy Worthy, Rita Ribas, Guilherme Ferreira-Dos-Santos, Joseph Bestic, Mark Friedrich B Hurdle
  • Anesthesiology and Pain Medicine
  • Neurology (clinical)
  • General Medicine



To describe and assess the feasibility of an ultrasound-guided technique for intra-articular injection of the costovertebral joints, in an unembalmed cadaveric specimen, utilizing fluoroscopy and cone beam computerized tomography for confirmation of contrast spread and needle tip position, respectively.


A single unembalmed cadaveric specimen was obtained. A single interventionist performed the placement of the needles under ultrasound guidance. Contrast dye was then injected through each of the needles under real-time fluoroscopy. Finally, the specimen was submitted to a cone beam computerized tomography with 3-dimensional acquisition and multiplanar reformatting to assess final needle tip position relative to the costovertebral joints.


18 spinal needles were placed under ultrasound guidance. Fluoroscopy showed four distinct patterns of contrast spread: intra-articular in the costovertebral joint (13 levels in total), epidural (1 level), intra-articular in the facet joint of the target level (3 levels) and undetermined (1 level). Cone-beam computerized tomography confirmed 13 out of 18 needles to be adequately placed in the costovertebral joints (72% of the total) and 5 out of the 18 needles to be misplaced: 3 needles were placed in the facet joint of the target level, and 2 needles were placed in the epidural space.


This study suggests that, when performed by experienced interventionists, this technique has an accuracy rate of 72%. Further studies are warranted before these results can be extrapolated to daily clinical practice.

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