
Systematic Review of Diagnostic Utility and Therapeutic Effectiveness of Cervical Facet Joint Interventions
Author(s) -
Frank J E Falco
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/323
Subject(s) - medicine , facet joint , observational study , psychological intervention , neck pain , facet (psychology) , physical therapy , systematic review , interventional pain management , evidence based medicine , randomized controlled trial , manual therapy , population , medline , physical medicine and rehabilitation , chronic pain , surgery , alternative medicine , lumbar , pathology , psychology , social psychology , environmental health , personality , psychiatry , political science , law , big five personality traits
Background: Chronic, recurrent neck pain is common and is associated with high pain intensity and disability, which is seen in 14% 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. However, these studies also have shown false-positive results in 27% to63% 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: A systematic review of cervical facet joint interventions.Objective: To evaluate the accuracy of diagnostic facet joint nerve blocks and the effectiveness of cervical facet joint interventions.Methods: Medical databases and journals were searched to locate all relevant literaturefrom 1966 through December 2008 in the English language.A review of the literature of the utility of facet joint interventions in diagnosing and managingfacet joint pain was performed according to the Agency for Healthcare Research and Quality(AHRQ) criteria for diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials.Level of Evidence: The level of evidence was defined as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).Outcome Measures: For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks which achieve at minimum 80% relief of pain andthe ability to perform previously painful movements. For therapeutic interventions, the primary outcome measure was pain relief (short-term relief up to 6 months and long-term reliefgreater than 6 months) with secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake.Results: Based on the utilization of controlled comparative local anesthetic blocks, the evidence for the diagnosis of cervical facet joint pain is Level I or II-1. The indicated evidencefor therapeutic cervical medial branch blocks is Level II-1. The indicated evidence for radiofrequency neurotomy in the cervical spine is Level II-1 or II-2, whereas the evidence is lackingfor intraarticular injections.Limitations: A systematic review of cervical facet joint interventions is hindered by thepaucity of published literature and lack of literature for intraarticular cervical facet jointinjections.Conclusions: The evidence for diagnosis of cervical facet joint pain with controlled comparative local anesthetic blocks is Level I or II-1. The indicated evidence for therapeutic facet joint interventions is Level II-1 for medial branch blocks, and Level II-1 or II-2 for radiofrequency neurotomy.Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medialbranch blocks, controlled comparative local anesthetic blocks, cervical radiofrequency neurotomy, cervical intraarticular facet joint injections