Can Neck Crease be Used as an Indicator of C6 Level in Stellate Ganglion Block?

Lee, Sung Keun; Lim, Hyun Kyung; Kim, Tae Jung; Han, Jeong Uk; Chung, Chong Kweon; Park, Dong Ho; Song, Jang Ho; Cha, Young Deog; Kim, Ji Young

Abstract

BACKGROUND: Stellate Ganglion Block (SGB) is a procedure performed frequently in pain clinics. However the palpation of cervical transverse processes is difficult in patients with short and thick necks. In these cases the neck crease is used as an indicator of cervical level in my department. The aim of this study is to evaluate the usefulness of neck creases as an indicator of C6 level.
METHODS
We observed fifty patients that experienced nerve blockade due to chronic pain or cancer-related pain. Patients laid down in supine position. They slightly elevated their chins and opened their mouths to relax neck muscles. A) The radiopaque line was laid in accordance with neck crease below the thyroid cartilage. B) Simultaneously, the radiopaque indicator was laid on the skin above the most prominent tubercle by palpation. We took an x-ray picture of the neck.
RESULTS
The probability that the lines crossed over C5, C6 and C7 were 16%, 71%, and 12% respectively. The probability that the most prominent tubercle accorded with C5, C6 and C7 were 16%, 69% and 14% respectively. There was no significant difference between method A) and B).
CONCLUSIONS
The most prominent palpable tubercle of the cervical spine can be used as an indicator of C6, but we can use the neck crease as a good indicator of C6 in cases where the neck can't be palpated well.