Management of cervical facet arthropathy
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Published:
Jan 30, 2018
Keywords:
cervical facet joint, ultrasound guidance, medial branch block, medial branch neurotomy
Main Article Content
Abstract
Chronic neck pain is a common chief complaint
in a pain clinic. This condition affects the patients’ work,
activities of daily living and also their quality of life.
A pain physician plays a major role in making a
diagnosis and providing care as a part of the
interdisciplinary pain management with an orthopedist
and a physiatrist. Chronic neck pain results from
various conditions such as cervical facet arthropathy,
degenerative disc disease, cervical nerve root
impingement and myofascial pain syndrome. Cervical
medial branch block is a pain intervention yielding
the diagnosis of cervical facet syndrome and pain relief. The pain physicians should have expertise in
chronic neck pain regarding the clinical diagnosis,
physical examination and imaging interpretation.
This review article aims to summarize and update
the technique of cervical medial branch block and
neurotomy in term of indication, contraindication,
patient selection and the latest evidence-based
support.
Article Details
Section
Review articles
References
Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA.
Comprehensive review of epidemiology, scope, and impact
of spinal pain. Pain physician. 2009;12(4):E35-70.
2. Bovim G, Schrader H, Sand T. Neck pain in the general
population. Spine. 1994;19(12):1307-9.
3. Manchikanti L, Singh V, Rivera J, Pampati V. Prevalence
of cervical facet joint pain in chronic neck pain. Pain
physician. 2002;5(3):243-9.
4. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence
of chronic cervical zygapophysial joint pain after
whiplash. Spine. 1995;20(1):20-5.
5. van Eerd M, Patijn J, Lataster A, Rosenquist RW, van Kleef
M, Mekhail N, et al. Cervical facet pain. Pain Pract. 2010;
10(2):113-23.
6. Bogduk N. On cervical zygapophysial joint pain after
whiplash. Spine. 2011;36(25 Suppl):S194-9.
7. Finlayson RJ, Etheridge JP, Tiyaprasertkul W, Nelems B,
Tran DQ. A randomized comparison between
ultrasound- and fluoroscopy-guided C7 medial branch
block. Reg Anesth Pain Med. 2015;40(1):52-7.
8. Finlayson RJ, Etheridge JP, Tiyaprasertkul W, Nelems B,
Tran DQ. A prospective validation of biplanar ultrasound
imaging for C5-C6 cervical medial branch blocks. Reg
Anesth Pain Med. 2014;39(2):160-3.
9. Manchukonda R, Manchikanti KN, Cash KA, Pampati V,
Manchikanti L. Facet joint pain in chronic spinal pain: an
evaluation of prevalence and false-positive rate of
diagnostic blocks. J Spinal Disord Tech. 2007;20(7):
539-45.
10. Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell
MV, Buenaventura RM, et al. An update of comprehensive
evidence-based guidelines for interventional techniques
in chronic spinal pain. Part II: guidance and
recommendations. Pain physician. 2013;16(2 Suppl):
S49-283.
11. Stephenson M. Diagnostic blocks of the cervical and
lumbar medial branches: an evidence based review
[Internet]. ACC Research: Evidence-Based Healthcare
Review; [modified 2015]; [about 60 p.]. Available from:
http://docplayer.net/54164538-Diagnostic-blocks-
of-the-cervical-and-lumbar-medial-branches-an-
evidence-based-review.html.
12. Manchikanti L, Boswell MV, Singh V, Pampati V,
Damron KS, Beyer CD. Prevalence of facet joint pain in
chronic spinal pain of cervical, thoracic, and lumbar
regions. BMC Musculoskelet Disord. 2004;5:15.
13. Barnsley L, Lord S, Bogduk N. Comparative local
anaesthetic blocks in the diagnosis of cervical
zygapophysial joint pain. Pain. 1993;55(1):99-106.
14. Manchikanti L, Singh V, Falco FJ, Cash KA, Fellows B.
Comparative outcomes of a 2-year follow-up of cervical
medial branch blocks in management of chronic neck
pain: a randomized, double-blind controlled trial. Pain
physician. 2010;13(5):437-50.
15. Lord SM, Barnsley L, Bogduk N. The utility of comparative
local anesthetic blocks versus placebo-controlled blocks for
the diagnosis of cervical zygapophysial joint pain. Clin
J Pain. 1995;11(3):208-13.
16. Falco FJ, Manchikanti L, Datta S, Wargo BW, Geffert S,
Bryce DA, et al. Systematic review of the therapeutic
effectiveness of cervical facet joint interventions: an
update. Pain physician. 2012;15(6):E839-68.
17. Verrills P, Mitchell B, Vivian D, Nowesenitz G, Lovell B,
Sinclair C. The incidence of intravascular penetration
in medial branch blocks: cervical, thoracic, and lumbar
spines. Spine. 2008;33(6):E174-7.
18. Finlayson RJ, Etheridge JP, Chalermkitpanit P,
Tiyaprasertkul W, Nelems B, Tran DQ, et al. Real-time
detection of periforaminal vessels in the cervical spine:
An ultrasound survey. Reg Anesth Pain Med. 2016;41(2):
130-4.
19. International Spine Intervention Society. Cervical medial
branch blocks. In: Bogduk N, editor. Practice guidelines
for spinal diagnostic & treatment procedures, 2nd ed.
San Francisco: International Spine Intervention
Society;2013.
20. Thonnagith A, Elgueta MF, Chalermkitpanit P, Tran DQ,
Finlayson RJ. Ultrasound-guided cervical medial branch
blocks: a technical review. Int J Phys Med Rehabil.
2016;4(329):1-6.
21. International Spine Intervention Society. Cervical medial
branch thermal radiofrequency neurotomy. In: Bogduk N,
editor. Practice guidelines for spinal diagnostic & treatment
procedures, 2nd ed. San Francisco: International Spine
Intervention Society:2013.
22. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N.
Percutaneous radio-frequency neurotomy for chronic
cervical zygapophyseal-joint pain. N Engl J Med.
1996;335(23):1721-6.
23. MacVicar J, Borowczyk JM, MacVicar AM, Loughnan
BM, Bogduk N. Cervical medial branch radiofrequency
neurotomy in New Zealand. Pain Med. 2012;13(5):647-54.
24. Cohen SP, Bajwa ZH, Kraemer JJ, Dragovich A, Williams
KA, Stream J, et al. Factors predicting success and failurefor cervical facet radiofrequency denervation: a multi-
center analysis. Reg Anesth Pain Med. 2007;32(6):
495-503.
25. Tiyaprasertkul W, Perez J. Injection of steroids before
radiofrequency ablation has a negative impact on lesion
size. Reg Anesth Pain Med. 2014;39(3):189-91.
26. Lee SH, Kang CH, Lee SH, Derby R, Yang SN, Lee JE,
et al. Ultrasound-guided radiofrequency neurotomy in
cervical spine: sonoanatomic study of a new technique
in cadavers. Clin Radiol. 2008;63(11):1205-12.
Comprehensive review of epidemiology, scope, and impact
of spinal pain. Pain physician. 2009;12(4):E35-70.
2. Bovim G, Schrader H, Sand T. Neck pain in the general
population. Spine. 1994;19(12):1307-9.
3. Manchikanti L, Singh V, Rivera J, Pampati V. Prevalence
of cervical facet joint pain in chronic neck pain. Pain
physician. 2002;5(3):243-9.
4. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence
of chronic cervical zygapophysial joint pain after
whiplash. Spine. 1995;20(1):20-5.
5. van Eerd M, Patijn J, Lataster A, Rosenquist RW, van Kleef
M, Mekhail N, et al. Cervical facet pain. Pain Pract. 2010;
10(2):113-23.
6. Bogduk N. On cervical zygapophysial joint pain after
whiplash. Spine. 2011;36(25 Suppl):S194-9.
7. Finlayson RJ, Etheridge JP, Tiyaprasertkul W, Nelems B,
Tran DQ. A randomized comparison between
ultrasound- and fluoroscopy-guided C7 medial branch
block. Reg Anesth Pain Med. 2015;40(1):52-7.
8. Finlayson RJ, Etheridge JP, Tiyaprasertkul W, Nelems B,
Tran DQ. A prospective validation of biplanar ultrasound
imaging for C5-C6 cervical medial branch blocks. Reg
Anesth Pain Med. 2014;39(2):160-3.
9. Manchukonda R, Manchikanti KN, Cash KA, Pampati V,
Manchikanti L. Facet joint pain in chronic spinal pain: an
evaluation of prevalence and false-positive rate of
diagnostic blocks. J Spinal Disord Tech. 2007;20(7):
539-45.
10. Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell
MV, Buenaventura RM, et al. An update of comprehensive
evidence-based guidelines for interventional techniques
in chronic spinal pain. Part II: guidance and
recommendations. Pain physician. 2013;16(2 Suppl):
S49-283.
11. Stephenson M. Diagnostic blocks of the cervical and
lumbar medial branches: an evidence based review
[Internet]. ACC Research: Evidence-Based Healthcare
Review; [modified 2015]; [about 60 p.]. Available from:
http://docplayer.net/54164538-Diagnostic-blocks-
of-the-cervical-and-lumbar-medial-branches-an-
evidence-based-review.html.
12. Manchikanti L, Boswell MV, Singh V, Pampati V,
Damron KS, Beyer CD. Prevalence of facet joint pain in
chronic spinal pain of cervical, thoracic, and lumbar
regions. BMC Musculoskelet Disord. 2004;5:15.
13. Barnsley L, Lord S, Bogduk N. Comparative local
anaesthetic blocks in the diagnosis of cervical
zygapophysial joint pain. Pain. 1993;55(1):99-106.
14. Manchikanti L, Singh V, Falco FJ, Cash KA, Fellows B.
Comparative outcomes of a 2-year follow-up of cervical
medial branch blocks in management of chronic neck
pain: a randomized, double-blind controlled trial. Pain
physician. 2010;13(5):437-50.
15. Lord SM, Barnsley L, Bogduk N. The utility of comparative
local anesthetic blocks versus placebo-controlled blocks for
the diagnosis of cervical zygapophysial joint pain. Clin
J Pain. 1995;11(3):208-13.
16. Falco FJ, Manchikanti L, Datta S, Wargo BW, Geffert S,
Bryce DA, et al. Systematic review of the therapeutic
effectiveness of cervical facet joint interventions: an
update. Pain physician. 2012;15(6):E839-68.
17. Verrills P, Mitchell B, Vivian D, Nowesenitz G, Lovell B,
Sinclair C. The incidence of intravascular penetration
in medial branch blocks: cervical, thoracic, and lumbar
spines. Spine. 2008;33(6):E174-7.
18. Finlayson RJ, Etheridge JP, Chalermkitpanit P,
Tiyaprasertkul W, Nelems B, Tran DQ, et al. Real-time
detection of periforaminal vessels in the cervical spine:
An ultrasound survey. Reg Anesth Pain Med. 2016;41(2):
130-4.
19. International Spine Intervention Society. Cervical medial
branch blocks. In: Bogduk N, editor. Practice guidelines
for spinal diagnostic & treatment procedures, 2nd ed.
San Francisco: International Spine Intervention
Society;2013.
20. Thonnagith A, Elgueta MF, Chalermkitpanit P, Tran DQ,
Finlayson RJ. Ultrasound-guided cervical medial branch
blocks: a technical review. Int J Phys Med Rehabil.
2016;4(329):1-6.
21. International Spine Intervention Society. Cervical medial
branch thermal radiofrequency neurotomy. In: Bogduk N,
editor. Practice guidelines for spinal diagnostic & treatment
procedures, 2nd ed. San Francisco: International Spine
Intervention Society:2013.
22. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N.
Percutaneous radio-frequency neurotomy for chronic
cervical zygapophyseal-joint pain. N Engl J Med.
1996;335(23):1721-6.
23. MacVicar J, Borowczyk JM, MacVicar AM, Loughnan
BM, Bogduk N. Cervical medial branch radiofrequency
neurotomy in New Zealand. Pain Med. 2012;13(5):647-54.
24. Cohen SP, Bajwa ZH, Kraemer JJ, Dragovich A, Williams
KA, Stream J, et al. Factors predicting success and failurefor cervical facet radiofrequency denervation: a multi-
center analysis. Reg Anesth Pain Med. 2007;32(6):
495-503.
25. Tiyaprasertkul W, Perez J. Injection of steroids before
radiofrequency ablation has a negative impact on lesion
size. Reg Anesth Pain Med. 2014;39(3):189-91.
26. Lee SH, Kang CH, Lee SH, Derby R, Yang SN, Lee JE,
et al. Ultrasound-guided radiofrequency neurotomy in
cervical spine: sonoanatomic study of a new technique
in cadavers. Clin Radiol. 2008;63(11):1205-12.