Long-term Follow-up of Cervical Facet Medial Branch Radiofrequency Treatment With the Single Posterior-lateral Approach: An Exploratory Study

Pain Practice

1. Maarten van Eerd MD, FIPP^1,2, 
2. Nelleke de Meij MSc^1,*, 
3. Erik Dortangs MD¹, 
4. Alfons Kessels MD, MSc³, 
5. Jan van Zundert MD, PhD, FIPP¹, 
6. Arno Lataster MSc⁴, 
7. Jacob Patijn MD, PhD¹, 
8. Maarten van Kleef MD, PhD, FIPP¹

Article first published online: 18 MAR 2013

DOI: 10.1111/papr.12043

Background

Over 50% of patients presenting to pain clinic with neck pain have the cervical facet joints as the source of pain. Radiofrequency (RF) treatment of the medial branch, innervating the facet joint, is a therapeutic option. The objectives of this study were to evaluate the therapeutic effect and its duration of RF treatment, using the single posterior-lateral approach in patients suffering from facet joint degeneration and to identify predictors for a long-term effect.

Methods

Of the 130 consecutive patients with axial neck pain referred to the University Pain Center Maastricht, 67 fulfilled the inclusion criteria. The therapeutic effect was measured using the Patients’ Global Impression of Change (PGIC) scale. Retrospective data were made complete using newly collected PGIC follow-up data. A Kaplan–Meier curve evaluated the long-term therapeutic effect. Possible predictors of outcome were evaluated.

Results

Two patients refused to participate and in the remaining 65 patients, overall pain relief was reported in 55.4% at 2-month follow-up. Moderately, important change of improvement and substantial change of improvement were seen in 50.8% of patients. At 3-year follow-up, 30% still reported pain reduction. Spinal treatment level was the only predictor found.

Conclusions

Radiofrequency treatment of the cervical facet joints using a single posterior-lateral approach is a promising technique in patients with chronic neck pain due to facet degeneration. The short-term and long-term therapeutic effects of this intervention justify a randomized controlled trial to estimate the efficacy of cervical facet joint RF treatment in a chronic neck pain population.

Facet Pain in Thoracic Compression Fractures

Pain Medicine

Volume 11, Issue 11, pages 1674–1677, November 2010

1. Raj Mitra MD, 
2. Huy Do MD, 
3. Todd Alamin MD, 
4. Ivan Cheng MD

Article first published online: 1 OCT 2010

Abstract

Objective.  To determine if thoracic facet joints may be a significant secondary pain generator in patients with compression fractures. Traditionally, pain from vertebral compression fractures has been attributed to vertebral body itself. Compression fractures have been shown to increase thoracic kyphosis and thereby increase the thoracic flexion moment; these changes eventually increase the shear stress on the posterior elements.

Design.  We present a small case series of patients with thoracic compression fractures managed with intra-articular facet injections.

Setting.  Tertiary care academic medical center.

Participants.  Two patients with thoracic compression fractures.

Interventions.  The subjects received fluoroscopically guided thoracic facet steroid injections for pain management.

Main Outcome.  Change in verbal analog pain score.

Results.  Patients with thoracic compression fractures received significant long-lasting relief after receiving fluoroscopically guided intra-articular injections.

Conclusion.  Facet joints may be abnormally stressed due to the increasing thoracic flexion moment in anterior compression fractures, which may serve as a secondary pain generator; intra-articular facet blocks may be an alternative to vertebroplasty.

Cervicogenic Headache: Evidence That the Neck is a Pain Generator

Headache: The Journal of Head and Face Pain

Volume 50 Issue 4, Pages 699 - 705

Published Online: 13 Apr 2010

CURRENT REVIEW: CLINICAL SCIENCE

Werner J. Becker, MD

From the University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.

Correspondence to  W.J. Becker, Division of Neurology, Foothills Hospital, 1403 29th St NW, Calgary, AB, Canada T2N 2T9.

  Conflict of Interest: None

Copyright Copyright © 2010 American Headache Society

ABSTRACT

This review was developed as part of a debate, and takes the "pro" stance that abnormalities of structures in the neck can be a significant source of headache. The argument for this is developed from a review of the medical literature, and is made in 5 steps.

It is clear that the cervical region contains many pain-sensitive structures, and that these are prone to injury. The anatomical and physiological mechanisms are in place to allow referral of pain to the head including frontal head regions and even the orbit in patients with pain originating from many of these neck structures. 

Clinical studies have shown that pain from cervical spine structures can in fact be referred to the head. 

Finally, clinical treatment trials involving patients with proven painful disorders of upper cervical zygapophysial joints have shown significant headache relief with treatment directed at cervical pain generators. 

In conclusion, painful disorders of the neck can give rise to headache, and the challenge is to identify these patients and treat them successfully.

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DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1526-4610.2010.01648.x About DOI

Whiplash-Associated Disorders

EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders 
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl 

ABSTRACT

Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.

In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.

Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).