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.

Work and neck pain: A prospective study of psychological, social, and mechanical risk factors

Pain, 07/28/2010
Jan Olav Christensenab1, Stein Knardahla1

Received 19 November 2009; received in revised form 20 May 2010; accepted 1 July 2010. published online 26 July 2010.
Abstract

To determine the impact of occupational psychological/social and mechanical factors on neck pain, a prospective cohort study with a follow-up period of 2years was conducted with a sample of Norwegian employees. The following designs were tested: (i) cross-sectional analyses at baseline (n=4569) and follow-up (n=4122), (ii) prospective analyses with baseline predictors, (iii) prospective analyses with average exposure over time [(T1+T2)/2] as predictor, and (iv) prospective analyses with measures of change in exposure from T1 to T2 as predictors. A total of 2419 employees responded to both the baseline and follow-up questionnaire. Data were analyzed using ordinal logistic regression. After adjustment for age, sex, neck pain at T1, and other exposure factors that had been estimated to be confounders, the most consistent risk factors were role conflict (highest OR 2.97, 99% CI: 1.29–6.74) and working with arms raised to or above shoulder level (highest OR 1.37, 99% CI: 1.05–1.78). The most consistent protective factors were empowering leadership (lowest OR 0.53, 99% CI: 0.35–0.81) and decision control (lowest OR 0.60, 99% CI: 0.36–1.00). Hence, psychological and social factors are important precursors of neck pain, along with mechanical factors. Although traditional factors such as quantitative demands and decision control play a part in the etiology of neck pain at work, in this study several new factors emerged as more important.


a The National Institute of Occupational Health, Norway
b Department of Psychology, University of Oslo, Norway

Corresponding author. Address: The National Institute of Occupational Health, P.O. Box 8149 Dep, N-0033 Oslo, Norway. Tel.: +47 23 19 52 58; fax: +47 23 19 52 00

Hyoid bone insertion tendinitis: clinicopathologic correlation

European Archives of Oto-Rhino-Laryngology Volume 264, Number 5 / May, 2007

Utku Aydil1 , Özgür Ekinci2, Ahmet Köybaşioğlu1 and Yusuf Kizil1

(1) Department of Otorhinolaryngology, Gazi Üniversitesi Tıp Fakültesi KBB AD, Gazi University School of Medicine, 06500 Beşevler/Ankara, Turkey
(2) Department of Pathology, Gazi University School of Medicine, 06500 Beşevler/Ankara, Turkey
Received: 25 August 2006 Accepted: 13 November 2006 Published online: 4 January 2007

Abstract
Hyoid bone insertion tendinitis is often not taken into consideration in clinical practice and neglected in the differential diagnosis while evaluating patients with chronic neck pain. One of the main important reasons why physicians do not bear this entity in mind is that it has not been well described histopathologically. Two patients, who had been diagnosed and treated surgically for hyoid bone insertion tendinitis, were presented in this study. Microscopically, degenerative changes in the striated muscle tissue, which are characterized by myocyte necrosis, atrophy along with fibrosis and calcification in some foci, were observed. These findings provide evidence for the clinical picture of hyoid bone insertion tendinitis.


Presented at 28th Turkish National Otorhinolaryngology and Head and Neck Surgery Congress, May 21–26, 2005, Belek/Antalya/Turkey.

The Prevalence of Neck Pain in Migraine

Headache 2010;••:••-••
Anne H. Calhoun, MD; Sutapa Ford, PhD; Cori Millen, DO; Alan G. Finkel, MD; Young Truong, PhD; Yonghong Nie, MS
From the Carolina Headache Institute, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Physical Medicine and Rehabilitation, Chapel Hill, NC, USA (S. Ford); Blue Sky Neurology, Denver, CO, USA (C. Millen); University of North Carolina, Department of Biostatistics, Chapel Hill, NC, USA (Y. Truong and Y. Nie).
Correspondence to A.H. Calhoun, Carolina Headache Institute, 103 Market Street, Chapel Hill, NC 27516, USA.
 Financial support: This investigator-initiated study was funded by GlaxoSmithKline.

  Conflict of Interest: Dr. Calhoun is a consultant for Merck. Dr. Finkel is on Merck speaker bureau; Dr. Calhoun receives research support and is a consultant for Teva Pharmaceuticals; Drs. Ford, Millen-Schnurr, Truong, and Ms. Nie have no conflicts to report.

Copyright © 2010 American Headache Society

ABSTRACT

Objective.—To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.

Methods.—This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).

Results.—Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea (P < .0001). Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.

Conclusions.—In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.


--------------------------------------------------------------------------------

Accepted for publication December 3, 2009.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01608.x About DOI

Cervical Radicular Pain

Pain Practice
Volume 10 Issue 1, Pages 1 - 17
 
Jan Van Zundert, MD, PhD, FIPP* † ; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.
Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks.
Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.

When conservative treatment fails, interventional treatment may be considered.

For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+).

In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.

Reduced head steadiness in whiplash compared with non-traumatic neck pain

Journal of Rehabilitation MedicineVol. 42/2010 > Iss. 1/January > pp. 35-41
Astrid Woodhouse, Pål Liljebäck, Ottar Vasseljen.
Original report
Abstract:
Objective: While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash-associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash-associated disorders (WAD), those with chronic non-traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated.
Methods: Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n = 59), non-traumatic neck pain (n = 57) and healthy controls (n = 57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness.
Results: The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task.

Conclusion: Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash-associated disorders. Decreased head steadiness was related to severe pain and dizziness.

Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials

The Lancet Early Online Publication, 13 November 2009 doi:10.1016/S0140-6736(09)61522-1

Dr Roberta T Chow MBBS, Prof Mark I Johnson PhD, Prof Rodrigo AB Lopes-Martins PhD, Prof Jan M Bjordal PT

Summary

Background

Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.

Methods

We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.

Findings

We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1·69 (95% CI 1·22—2·33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4·05 (2·74—5·98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19·86 mm (10·04—29·68). Seven trials provided follow-up data for 1—22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22·07 mm (17·42—26·72). Side-effects from LLLT were mild and not different from those of placebo.

Interpretation

We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students

Journal of Manipulative and Physiological Therapeutics

Volume 32, Issue 8, Pages 625-634 (October 2009)  Sue A. Weber Hellstenius, DC, MSc

Received 29 April 2009; received in revised form 26 June 2009; accepted 27 June 2009.

Abstract 

Objective

To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.

Methods

A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the χ2 test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill).

Results

Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.

Conclusion

In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.

Is cervical spinal manipulation dangerous?

Journal of Manipulative and Physiological Therapeutics 2003;26:48-52

Peter B. Licht, MD, PhD, Henrik W. Christensen, DC, MD, Poul F. Høilund-Carlsen, MD, DMSc

Abstract 

Objective: Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae. Clinical Features: A 39-year-old man with nonspecific neck pain was treated by his general practioner with cervical manipulation. Intervention and Outcome: This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries. Conclusion: It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated. (J Manipulative Physiol Ther 2003;26:48-52)

Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students

Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 8, Pages 625-634 (October 2009)

Sue A. Weber Hellstenius, DC, MSc

Received 29 April 2009; received in revised form 26 June 2009; accepted 27 June 2009.

Abstract 

Objective

To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.

Methods

A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the χ2 test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill).

Results

Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.

Conclusion

In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.

Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Stud

Journal of Manipulative and Physiological Therapeutics, Volume 32, Issue 8, Pages 625-634 (October 2009)Sue A. Weber Hellstenius, DC, MSc
Received 29 April 2009; received in revised form 26 June 2009; accepted 27 June 2009.

Abstract
Objective
To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.

Methods
A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the χ2 test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill).

Results
Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.

Conclusion
In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.

Cervical Radicular Pain

EVIDENCE BASED MEDICINE

Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice


Published Online: 5 Oct 2009

Journal compilation © 2009 World Institute of Pain


ABSTRACT

Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.