Authors' Response to Letter to the Editor “Ultrasound-Guided C7 Cervical Medial Branch Block Using the In-Plane Approach”

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To the Editor:
We read with interest the recent “Letter to the Editor” in which our paper entitled “Spinal Cord Injury During Ultrasound-Guided C7 Cervical Medial Branch Block1” recommended ultrasound-guided C7 cervical medial branch block (CMBB) using in-plane approach.
This “Letter to the Editor” nicely demonstrated two methods of ultrasound-guided C7 CMBB, and we think that this “Letter to the Editor” is very helpful with physiatrists in clinical practice. The authors suggested one of the following three methods to avoid complications in the traditional method using out-plane: using a “walk-down” technique or using a short-needle that does not reach to the spinal cord or using in-plane approach. Among them, the authors strongly suggested the in-plane approach, which can visualize the whole needle trajectory, and we also fully agree with that. The advantages of ultrasound-guided CMBB are that radiation exposure can be avoided and complications, such as vessel or nerve injuries, can be minimized by observing other vital tissues in real time.2 However, CMBB using the out-plane approach can offset these advantages of ultrasound because out-plane approach can`t visualize the whole needle trajectory.
For a better understanding of clinicians who are not familiar with ultrasound-guided CMBB, we attached several figures of cervical spine anatomy, such as medial branch nerve (Fig. 1A, B) and cervical spine bony structures (Fig. 1C) used as landmark for ultrasound-guided CMBB. We hope that our response to the letter to the editor will help many clinicians.
Thank you for the opportunity to response to the letter about our previously case report.

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