CERVICAL FACET JOINT SYNDROME


Facts:

  1. Accounts for 40-65% of neck pain.
    May occur in absence of x-ray, CT, or MRI findings.
    Physical examination is more specific than in the lumbar area.
  2. May be traumatic or atraumatic.

Symptoms: (see Cervical Facet Pain Maps)

  1. Neck pain.
    Pain worse in evenings than in the mornings.
    Pain may radiate into the shoulders, scapula and upper back.
    Pain may radiate down the arm though usually not below the elbow.
  2. Pain worsened by extension, rotation, and lateral bending.

Diagnosis:

  1. Tender joints when examined posteriorly and laterally. The only reliable method is to perform precision facet nerve blocks (medial branch) under fluoroscopy with local anesthetic. If this relieves the pain for the duration of the local anesthetic, the facet joints are deemed to be pain generators.
  2. The blocks are repeated to assure accuracy.

Treatment:

  1. Radiofrequency medial branch rhizotomy. Using a 22 gauge needle and a radiofrequency probe, the facet nerves can be located and ablated in a short and relatively painless procedure. This lasts between 3 months and a year, with a mean time of 272 days. The treatment may be repeated.

Cervical Facet Pain Map


Cervical Facet Pain Map 2

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