scholarly journals An Updated Review of the Diagnostic Utility of Cervical Facet Joint Injections

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E807-E838
Author(s):  
Sukdeb Datta
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Diagnostic Accuracy ◽  
Joint Pain ◽  
Facet Joint ◽  
Chronic Neck Pain ◽  
Nerve Blocks ◽  
Facet Joint Pain ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Chronic persistent neck pain with or without upper extremity pain is common in the general adult population with a prevalence of 48% for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple modalities of treatment are exploding in managing chronic neck pain along with increasing prevalence. However, there is a paucity of evidence for all modalities of treatments in managing chronic neck pain. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 60% in heterogenous population of these patients. However, these studies also have shown false-positive results in 27% to 63% of patients with a single diagnostic block. Study Design: A systematic review of diagnostic cervical facet joint nerve blocks. Objective: To evaluate and update the accuracy of diagnostic facet joint nerve blocks in the diagnosis of facet joint pain. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and critically analyzed. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Results: Overall, a total of 26 manuscripts were considered for diagnostic accuracy evaluation and 9 manuscripts for studies evaluating various factors influencing the diagnostic validity of facet joint interventions. Based on 9 studies meeting the inclusion criteria utilizing 75% to 100% pain relief as the criterion standard with controlled blocks, the evidence is good for diagnostic accuracy of cervical facet joint pain, with a prevalence of 36% to 60% with a false-positive rate of 27% to 63% with a single block. Based on 2 studies from the same group of authors, the evidence for 75% to 100% pain relief as the criterion standard with a single block is limited. The evidence is limited for a single diagnostic block with 50% to 74% pain relief as the criterion standard, whereas no studies were available assessing the accuracy of 50% to 74% pain relief as the criterion standard with controlled blocks. Limitations: The limitations of this systematic review include a paucity of literature on outcomes, randomized, placebo-controlled trials and a lack of consensus on a gold standard. Conclusions: Diagnostic cervical facet joint nerve blocks are safe, valid, and reliable. The strength of evidence for diagnostic facet joint nerve blocks is good with the utilization of controlled diagnostic blocks with at least 75% pain relief as the criterion standard; however, the evidence is limited for single blocks or dual blocks for relief of 50% to 74% and single blocks with at least 75% pain relief. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medial branch blocks, controlled comparative local anesthetic blocks

The Benefit of Therapeutic Medial Branch Blocks after Cervical Operations

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 527-534
Author(s):  
Stephan Klessinger
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Medial Branch Block ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. Objectives: The objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. Study Design: Retrospective practice audit. Setting: Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. Methods: Patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). A positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. All patients with a minimum follow up time of 6 month were included. Results: Of the 312 operations performed, 128 were artificial disc operations, 125 were stand alone cages, and 59 were fusions with cage and plate. Persistent neck pain occurred in 33.3 % of the patients. There was no difference between the patients with neck pain and the whole group of patients. More than half of the patients with neck pain—52.9%—were treated successfully with therapeutic medial branch blocks. Since no further treatment was necessary, the initial treatment was considered successful. Nearly a third—32.2%—of the patients were initially treated successfully, but their pain recurred and further diagnostics and treatments were necessary. In this group of patients, significantly more with double level operations were found (P = 0.003). Patients not responding to the medial branch block were 14.9%. Limitations: This audit is retrospective and observational, and therefore does not represent a high level of evidence. However, to our knowledge, since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists, it appears to be the best available research upon which to recommend treatment and to plan higher quality studies. Conclusions: For persistent postsurgical neck pain only limited therapy recommendations exist. This study suggests treating these patients in a first instance with therapeutic medial branch blocks. The success rate is 52.9 %. Key words: Chronic neck pain, cervical zygapophysial pain, cervical facet joint pain, medial branch blocks, therapeutical cervical facet joint nerve blocks, postsurgery syndrome, pain therapy Pain Physician

scholarly journals Comparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint Pain

2017 ◽  
Vol 6 (20;6) ◽  
pp. E961-E967
Author(s):  
Min Cheol Chang
Keyword(s):  
Pain Relief ◽  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Corticosteroid Injection ◽  
University Hospital ◽  
Pulsed Radiofrequency ◽  
Facet Joint Pain ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Disorders of the facet joints are some of the most common sources of chronic spinal pain. Facet joint pain is responsible for approximately 50% of patients with chronic neck pain. Pulsed radiofrequency (PRF) stimulation, after placing needle electrodes into the joint space, has been recently reported for the management of joint pain. Objective: The aim of this study was to evaluate the effect of intraarticular (IA) PRF for the management of cervical facet joint (CFJ) pain. In addition, we compared the effect of IA PRF to IA corticosteroid injection. Study Design: Prospective observational study. Setting: University hospital. Methods: Forty patients with CFJ pain were included in the study and randomly assigned to one of 2 groups: the IA PRF group and the IA corticosteroid (ICI) group. There were 20 patients in each group. Pain intensity was evaluated using a numeric rating scale (NRS) at pre-treatment, and one, 3, and 6 months after treatment. Results: When compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at one, 3, and 6 months after treatment (P = 0.000). Changes in the NRS scores over time were not significantly different between the groups (P = 0.227). Six months after treatment, 10 patients (50.0%) in the PRF group and 12 patients (60.0%) in the ICI group reported successful pain relief (pain relief of ≥ 50%). Limitations: A small number of participants. Conclusion: IA PRF stimulation is as effective as IA corticosteroid injection in attenuating CFJ pain. The use of PRF could decrease CFJ pain, while avoiding the adverse effects of steroids.

scholarly journals A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. E497-E533 ◽  
Author(s):  
Mark Boswell
Keyword(s):  
Pain Relief ◽  
Diagnostic Accuracy ◽  
Joint Pain ◽  
Facet Joint ◽  
Spinal Pain ◽  
Nerve Blocks ◽  
Zygapophysial Joint ◽  
Level Ii ◽  
Cervical Facet ◽  
Chronic Spinal Pain

Background: Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. Study Design: A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. Objective: To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements. Results: The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II with 80% or higher pain relief as the criterion standard with a prevalence ranging from 34% to 48% and false-positive rates ranging from 42% to 48%. Limitations: The shortcomings of this systematic review include a paucity of literature related to the thoracic spine, continued debate on an appropriate gold standard, appropriateness of diagnostic blocks, and utility. Conclusion: The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks, Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks in assessment of chronic spinal pain. Key words: Chronic spinal pain, lumbar facet or zygapophysial joint pain, cervical facet or zygapophysial joint pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks

scholarly journals 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

2010 ◽  
Vol 5;13 (5;9) ◽  
pp. 437-450 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Medial Branch ◽  
Group I ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Cervical therapeutic intraarticular facet joint injections, therapeutic medial branch blocks, and radiofrequency neurotomy have been applied in managing chronic neck pain of cervical facet joint origin. However, the effectiveness of these modalities continues to be debated. The purpose of this study was to determine the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids. Study Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the clinical outcomes of therapeutic cervical medial branch blocks with local anesthetic with or without steroids in managing chronic neck pain of facet joint origin. Methods: A total of 120 patients meeting inclusion criteria were included. All of the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, with at least 80% relief. Group I consisted of cervical medial branch blocks with bupivacaine only and Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Therapeutic cervical medial branch blocks with local anesthetic with or without steroids were administered. Main outcome measures included numeric pain scores, Neck Disability Index (NDI), opioid intake, and work status evaluated at baseline, 6, 12, 18, and 24 months. The one-year results of outcomes were published in 2008. This manuscript describes the 2-year results. Significant improvement was defined as at least 50% improvement in pain relief and/or functional status improvement. Outcomes Assessment: Patient outcomes were measured at baseline, 3, 6, 12, 18, and 24 months post-treatment with the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant. Results: Eighty-five percent of patients in Group I and 93% of patients in Group II showed significant pain relief (≥ 50%) at 2 years. The average number of treatments for 2 years was 5.7. The duration of average pain relief with each procedure was 17-19 weeks on average in both groups. Significant improvement of pain and function was demonstrated for 83 to 89 weeks over a period of 2 years. Limitations: The study limitations include the lack of a placebo group. Conclusions: In this study, therapeutic cervical medial branch blocks instituted after the diagnosis, with controlled comparative local anesthetic blocks with 80% concordant pain relief, repeated approximately 6 times over a period of 2 years, provided significant improvement over a period of 2 years. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic cervical facet joint nerve blocks

Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance

2006 ◽  
Vol 108 (7) ◽  
pp. 709-711 ◽  
Author(s):  
Josef G. Heckmann ◽  
Christian Maihöfner ◽  
Stefan Lanz ◽  
Christophe Rauch ◽  
Bernhard Neundörfer
Keyword(s):  
Neck Pain ◽  
Facet Joint ◽  
Chronic Neck Pain ◽  
Joint Injection ◽  
Facet Joint Injection ◽  
Imaging Guidance ◽  
Cervical Facet ◽  
Cervical Facet Joint

scholarly journals Systematic Review of the Therapeutic Effectiveness of Cervical Facet Joint Interventions: An Update

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E839-E868 ◽  
Author(s):  
Frank J.E. Falco
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Joint Pain ◽  
Observational Studies ◽  
Facet Joint ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Facet Joint Interventions ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: The prevalence of chronic, recurrent neck pain is approximately 15% of the adult general population. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 67% of these patients, when disc herniation, radiculitis, and discogenic are not pathognomic. However, these studies also have shown false-positive results in 27% to 63% of the patients with a single diagnostic block. There is also a paucity of literature investigating therapeutic interventions of cervical facet joint pain. Study Design: Systematic review of therapeutic cervical facet joint interventions. Objective: To determine and update the clinical utility of therapeutic cervical facet joint interventions in the management of chronic neck pain. Methods: The available literature for utility of facet joint interventions in therapeutic management of cervical facet joint pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: In this systematic review, 32 manuscripts were considered for inclusion. For final analysis, 4 randomized trials and 6 observational studies met the inclusion criteria and were included in the evidence synthesis. Based on one randomized, sham-controlled, double-blind trial and 5 observational studies, the indicated evidence for cervical radiofrequency neurotomy is fair. Based on one randomized, double-blind, active-controlled trial and one prospective evaluation, the indicated evidence for cervical medial branch blocks is fair. Based on 2 randomized controlled trials, the evidence for cervical intraarticular injections is limited. Limitations: Paucity of the overall published literature and specifically lack of literature for intraarticular cervical facet joint injections. Conclusions: The indicated evidence for cervical radiofrequency neurotomy is fair. The indicated evidence for cervical medial branch blocks is fair. The indicated evidence for cervical intraarticular injections with local anesthetic and steroids is limited. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medial branch blocks, cervical radiofrequency neurotomy, cervical intraarticular facet joint injections

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