Abstract
Cervical facet joint (CFJ) syndrome is a common cause of neck pain. For its diagnosis and treatment, CFJ injection with arthrogram is generally performed. This study aimed to investigate the frequency of extra-CFJ flow on CFJ arthrograms during injections and its differences according to age, sex, and cervical vertebral level. We analyzed 760 CFJ arthrograms administrated to 208 patients diagnosed with CFJ syndrome. Arthrograms at each vertebral level were collected to evaluate the normal CFJ and extra-CFJ flow. The primary and secondary outcomes were frequency of extra-CFJ flow according to cervical vertebral level, age, and sex and according to pairwise cervical levels, respectively. Extra-CFJ flow at the cervical spine occurred during 179 injections, and the overall incidence was 3.3–36.2% at different cervical levels. The incidence of extra-CFJ flow at each cervical vertebral level according to age and sex was not significant. Extra-CFJ flow was the highest at C6 and C7, but there was no statistical significance. Extra-CFJ flow was higher at lower vertebral levels (C5–C7) than at upper levels (C3 and C4). Additional clinical studies and anatomical evaluations are needed to support its clinical value and enable the development of new injection techniques.
Highlights
The prevalence of neck pain is common in the general population [1]
Cervical facet joint (CFJ) syndrome is a common cause of neck and shoulder pain, and its prevalence ranges from 25 to 65% according to the criteria of the International Association for the Study of Pain [3]
The CFJs are innervated by the medial branches of the dorsal rami of the cervical nerves, which can be blocked by physicians for verifying the pathological origin of neck pain or treating the symptom [5,6]
Summary
Neck pain can be defined as pain in the area between the skull base and the first thoracic vertebra, and may often radiate to the head or to the upper arm [2]. This kind of neck pain usually is related to nociceptive stimuli from various structures near to the vertebral column, such as muscles, ligaments including the intervertebral disc, nerve roots, and facet joints, which are often difficult to detect precisely between radicular or non-radicular pain in clinical practice. Many previous studies have been reported about the clinical effects of the medial branch block [9,10] and radiofrequency neurotomy [8], whereas only a few studies have attempted to reveal the CFJ injection [11]
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