Introduction/purpose Aim of this educational exhibit is to offer an overview on neuroradiological armamentarium in the minimally invasive percutaneous image-guided procedures on cervical spine.

Materials and Methods Spinal neuro-interventional radiology offers a wide variety of percutaneous procedures for tissue diagnosis, draianage of fluid collections, pain management, diagnostic and therapeutic blocks, radiofrequency ablations, disc procedures, osteoporotic and neoplastic vertebral fractures treatment. Procedures under fluoroscopy and/or CT guidance, with different approaches (anterior, lateral, posterior, transmaxillary, and trans-oral), will be shown, and indications, relevant anatomy, procedural techniques will be outlined. -Anterior approach: Under fluoroscopic or CT guidance, it is used to access: Disc spaces: for biopsy, discography, percutaneous disc decompression; Vertebral bodies: from C4 to C7, for biopsy, cement vertebral augmentation, percutaneous tumor ablation; Stellate ganglion: for diagnostic, prognostic and therapeutic blocks in painful and non-painful conditions related to sympathetic dysfunctions of head, neck and upper extremities -Lateral approach: Under fluoroscopic or CT guidance, it is used to access: Central canal at C1-C2 for CSF collection or myelography; Neuroforamina C3-C8: for diagnostic, prognostic and therapeutic blocks in radicular pain; Zygoapophyseal joints: for diagnostic, prognostic and therapeutic blocks in facet-related pain; Median branch nerves: for diagnostic and prognostic blocks in facet-related pain -Posterior approach: Under fluoroscopic or CT guidance, it is used to access: Interlaminar space: for epidural blocksPosterior bony elements: for bone biopsies and cementoplasty; C1 lateral masses: for bone biopsies and cementoplasty; C1 and C2 neuroforamina: for diagnostic, prognostic and therapeutic blocks in radicular pain; C1-C2 joint: for diagnostic, prognostic and therapeutic blocks; Zygoapophyseal joints: for diagnostic, prognostic and therapeutic blocks in facet-related pain; Radiofrequency median branch denervation: for pain management of facet-related pain; Radiofrequency transverse occipital nerve denervation: for pain management of occipital neuralgia -Transmaxillary approach: Under CT guidance, it is used to access: C1 and C2 anterior bony elements: for biopsy, cement vertebral augmentation, percutaneous tumor ablation -Transoral approach: Under fluoroscopic guidance, it is used to access: C1-C3 anterior bony elements: for biopsy, cement vertebral augmentation, percutaneous tumor ablation.

Results A wide variety of image-guided cervical spine procedures are illustrated, with their different approaches. Fluoroscopic or CT guidance can be chosen on the basis of personal preference, anatomical features, type of approach, and specific procedure to be performed. Percutaneous image-guided procedures on the cervical spine require thorough knowledge of loco-regional anatomy, precise and reliable imaging guidance, and rigorous technique, due to the complex, delicate, and vital anatomical environment, to avoid serious complications. Elements of relevant fluoroscopic and cross sectional anatomy, as well as procedural technique elements are discussed and displayed.

Conclusion This educational exhibit illustrates a wide variety of percutaneous image-guided accesses to the cervical spine, utilized for diagnostic and therapeutic purposes, their indications, the anatomy and the techniques, under Fluoroscopy or CT guidance.

Competing interests None.