Cervical Facet Joint Interventions

Chronic neck pain is second only to low back pain in commonality, with third most common cause of disability resulting in high healthcare costs. The overwhelming literature shows that neck pain ranks as number 3 among the 30 leading disease and injuries causing disability and contributing to high health care costs. Multiple structures in the cervical spine, including cervical facet joints, have been shown to be capable of transmitting pain in the cervical spine with resulting symptoms of neck pain, upper extremity pain, and headache. Utilizing controlled comparative local anesthetic blocks the chronic cervical facet joint pain was shown to have a prevalence of 29–60% and false-positive rates of 27–63% with high variability. Multiple therapeutic interventions have been utilized among which interventional techniques with cervical intraarticular injections, cervical medial branch nerve blocks, and cervical radiofrequency neurotomy are common procedures. Evidence derived from guidelines and systematic reviews shows Level II evidence with moderate recommendation for cervical radiofrequency neurotomy and therapeutic cervical facet joint nerve blocks, whereas the evidence for therapeutic cervical intraarticular injections has been shown to be Level V with weak strength of recommendation.