Cervical Facet Joints and Intraarticular Injection of Biologics

Chronic neck pain, is the third leading cause of disability in the general population. Various structures in the cervical spine can generate pain, including intervertebral discs, cervical facet joints, ligaments, muscles, and nerve root dura. Cervical facet joints are a significant source of neck pain and can also refer pain to the head and upper extremities. The prevalence of persistent neck pain due to cervical facet joint involvement ranges from 36% to 67%, with a false-positive rate of 27–63% based on diagnostic blocks. Neuroanatomic, neurophysiologic, and biomechanical studies have identified nerve endings and inflammatory markers in the cervical facet joints. Facet joint pain can be induced by mechanical injury and inflammation. Conventional clinical features are unreliable for diagnosing facet joint pain, and diagnostic blocks are recommended. Treatment options for facet joint pain include intraarticular injections, facet joint nerve blocks, and radiofrequency neurotomy. The field of regenerative medicine has also explored the use of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) for managing facet joint pain. Intraarticular facet joint injections can be performed using posterior or lateral approaches. Understanding the radiographic and fluoroscopic anatomy is crucial for these procedures.