Cervical Facet Joint Research Articles

Effect of Facet Tropism on the Degeneration of the Cervical Facet Joint and Intervertebral Disc

Effect of Facet Tropism on the Degeneration of the Cervical Facet Joint and Intervertebral Disc

Efficacy of radiofrequency lesioning for chronic spinal pain: A systematic review

Introduction: Facet joint pain, discogenic pain, sacroiliac joint (SIJ) pain, and radicular pain are chronic spinal pain conditions, where radiofrequency (RF) lesioning has been used so far with variable results. It is always desired to choose a therapeutic option based on its current evidence. The present systematic review has focused on the efficacy of RF lesioning for chronic spinal pain conditions. Methods: A literature search was done in PubMed from the year 1966 onward. The basic idea of the literature search was to find out studies focusing on RF lesioning for chronic spinal pain. The randomized controlled trials and observational studies focusing on RF lesioning for chronic spinal pain of more than 3 months duration have been included in this review. Results: A total of 286 studies have been identified after literature search and assessed for inclusion in this review. Forty-two of these studies meeting the inclusion criteria have been included for the formulation of evidence; 26 of these studies were of high quality, 14 were of moderate quality, and 2 were of low quality as per Cochrane review criteria score. The level of evidence for RF lesioning of conditions giving rise to nonradicular pain is Level I for continuous RF lesioning of lumbar facet medial branch, for both short- and long-term effectiveness; level II evidence for continuous RF lesioning of cervical facet medial branch, continuous RF or cooled RF lesioning of SIJ and bipolar cooled RF in intradiscal biacuplasty for discogenic pain, for both short- and long-term effectiveness; level III evidence for continuous RF lesioning of thoracic facet medial branch. For radicular pain management, there is Level II evidence for dorsal root ganglion (DRG) pulsed RF lesioning, for both short- and long-term effectiveness. Conclusion: The evidence for RF lesioning of chronic spinal pain is summarized as follows: Nonradicular pain. Cervical facet joint pain: Level II evidence for continuous RF lesioning of cervical facet medial branch. Thoracic facet joint pain: Level III evidence for continuous RF lesioning of thoracic facet medial branch. Lumbar facet joint pain: Level I evidence for continuous RF lesioning of lumbar facet medial branch. Sacro-iliac joint pain: Level II for continuous RF or cooled RF lesioning of SIJ. Discogenic pain: Level II evidence for bipolar cooled RF in intradiscal biacuplasty for discogenic pain. Radicular Pain: Level II evidence for DRG pulsed RF lesioning for the management of radicular pain.

Fluoroscopic Findings of Extra-Cervical Facet Joint Flow and Its Incidence on Cervical Facet Joint Arthrograms.

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.

Efficacy and Long-term Effect of Radiofrequency Denervation in Patients with Clinically Diagnosed Cervical Facet Joint Pain: A Double-blind Randomized Controlled Trial.

Multicenter double-blind randomized sham-controlled trial. To assess the efficacy of radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain. One randomized controlled trial showed efficacy of RF denervation in whiplash-associated disease. There are no randomized controlled trials on RF denervation in patients with chronic cervical facet joint pain. Patients were randomized to receive RF denervation combined with bupivacaine (intervention group) or bupivacaine alone (control group). In the intervention group, an RF thermal lesion was made at the cervical medial branches after the injection of bupivacaine. The primary outcome was measured at 6 months and consisted of pain intensity, self-reported treatment effect, improvement on the Neck Disability Index, and the use of pain medication. Duration of effect was determined using telephone interviews. We included 76 patients. In the intervention group, 55.6% showed > 30% pain decrease versus 51.3% in the control group (P = 0.711); 50.0% reported success on the Patients' Global Impression of Change in the intervention group versus 41.0% (P = 0.435); the Neck Disability Index was 15.0 ± 8.7 in the intervention group compared with 16.5 ± 7.2 (P = 0.432), the need for pain medication did not differ significantly between groups (P = 0.461). The median time to end of treatment success for patients in the RF group was 42 months, compared with 12 months in the bupivacaine group (P = 0.014). We did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia only at 6 months follow-up. We found a difference in the long-term effect after 6 months follow-up in favor of the RF treatment.Level of Evidence: 2.

Assessment of Prevalence of Cervical Facet Joint Pain with Diagnostic Cervical Medial Branch Blocks: Analysis Based on Chronic Pain Model

Research into cervical spinal pain syndromes has indicated that the cervical facet joints can be a potent source of neck pain, headache, and referred pain into the upper extremities. There have been multiple diagnostic accuracy studies, most commonly utilizing diagnostic facet joint nerve blocks and an acute pain model, as Bogduk has proposed. Subsequently, Manchikanti has focused on the importance of the chronic pain model and longer lasting relief with diagnostic blocks. To assess diagnostic accuracy of cervical facet joint nerve blocks with controlled comparative local anesthetic blocks, with updated assessment of prevalence, false-positive rate, and a description of philosophical paradigm shift from acute to chronic pain model, with concordant pain relief. This diagnostic accuracy study was performed with retrospective assessment of data to assess prevalence and false-positive rates. The study was performed in a non-university-based, multidisciplinary, interventional pain management, private practice in the United States. Cervical medial branch blocks were performed utilizing lidocaine 1% followed by bupivacaine 0.25% when appropriate response was obtained in an operating room under fluoroscopic guidance with 0.5 mL of lidocaine or bupivacaine from C3-C6 medial branches (levels blocked on joints involved). If a patient failed to respond to lidocaine with appropriate >= 80% pain relief, that patient was considered as negative for facet joint pain. If the response was positive with lidocaine block, a bupivacaine block was performed. The chronic cervical facet joint pain was diagnosed with cervical facet joint nerve blocks at a prevalence of 49.3% (95% CI, 43.6%, 55.0%) and with a false-positive rate of 25.6% (95% CI, 19.5%, 32.8%). This study also showed a single block prevalence rate of 66.3% (95% CI, 71.7%, 60.9%). Assessment of the duration of relief with each block showed greater than 80% for 6 days with lidocaine block and total relief of >= 50% of 31 days. In contrast, with bupivacaine, average duration of pain relief of >= 80% was 12 days with a total relief of >= 50% lasting for 55 days. Based on this investigation, utilizing a chronic pain model, there was significant difference in the relief patterns. This assessment showed prevalence and false-positive rates of 49.3% and 25.6% in chronic neck pain. Duration of relief >= 80% pain relief was 6 days with lidocaine and 12 days with bupivacaine, with total relief of >= 50% of 31 days with 55 days respectively.

Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation.

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.

Management of Unilateral Cervical Facet Joint Dislocation in Neurologically Intact Patients: Results of an Ao Spine latin American Survey

The treatment of unilateral CFD in patients without neurologic deficits remains controversial, especially in the choice of the best surgical approach. Our objective is to determine the way spine surgeons from Latin America manage this condition. A survey regarding management and surgical strategies was conducted by the AO Spine Latin American Trauma Study Group considering the treatment of unilateral CFD. All AO Spine Latin American Trauma Study Group members were sent a link to the survey, among whom 285 replied, with 197 respondents answering all the questions. Nonsurgical management was considered by 25% of the surgeons. The majority stated that magnetic resonance imaging is necessary (65%) to treat this type of patient. A posterior approach was preferred by 44%, an anterior approach by 29%, and a combined approach by 25%, while 2.2% did not answer. Traction was not used by the majority of respondents (62%). In the setting of an anterior disk herniation, the majority of surgeons preferred to employ an anterior (45%) or combined (44%) approach versus an isolated posterior approach (only 0.5%). Comparing early versus late cervical trauma, fewer surgeons adopted an isolated anterior approach with the latter (29% vs. 15%). Wide variations exist in the management of unilateral CFD by Latin American surgeons, with early injuries generally treated using either an anterior or posterior approach and treated early but after an MRI, while a combined approach is used more commonly with late injuries. Either an anterior or combined approach is used when disk herniation is present.

Motion preservation after cervical total disc replacement surgery-fact or fiction?

Cervical disc replacement surgery aims to preserve cervical motion in younger patients who present with symptomatic degenerative cervical disc herniation and mobile facet joints. We aimed to determine the demographics, pre-operative range of motion, operative parameters, post-operative parameters, range of motion at 2-years post-operatively, in 27 patients who presented to our unit over a 6-year period who underwent cervical total disc replacement surgery. Materials and methodsWe performed a retrospective chart review of 27 patients who presented to our unit with degenerative cervical disc disease, from 01 January 2014 – 31 December 2019, who underwent cervical disc replacement surgery. The data collected included patient age; gender; mechanism of injury; clinical presentation; cervical level/s involved; description and site of the disc herniation; length of preoperative symptomatology; pre-operative cervical range of motion; length of operative procedure; volume of intra-operative blood loss; amount of immediate post-operative radiculopathy pain assessed by the visual analogue scale; complications; length of hospital stay; and cervical range of motion at 2-year follow-up. ResultsThe mean age of our subjects was 45.5 (+/-6.5) years. Regarding gender 11/27 (41%) subjects were female and 16/27 (59%) subjects were male. In terms of number of levels 21/27 (78%) subjects had single level surgery and 6/27 (22%) subjects had double level surgery. Considering age categories, patients in the 4th decade demonstrated a statistically significant increase between their pre-operative segmental range of cervical flexion and their post-operative segmental range of cervical flexion (p = 0.02). ConclusionThrough the results of our study we report that in our 27 subjects cervical total disc replacement surgery was motion preserving in 100% of our subjects at a 2-year study end point. We further report that all our subjects demonstrated some degree of increase in their segmental ranges of motion in all planes, although this was largely insignificant.

Assessment of outcomes after surgical treatment of an isolated facet-syndrome in the cervical spine using facet joint laser denervation

Chronic pain in the cervical spine is one of the relevant problems of modern vertebrology. This is due to the polyetiological formation of clinical symptoms and to the variety of surgical techniques, which are often used without taking into account the leading pathomorphological substrate of clinical symptoms. Purpose: To analyze clinical results of surgical treatment of an isolated facet-syndrome of the cervical spine using laser denervation of facet joints (FJ).Material and methods. The study included 234 patients aged in average 58 (53; 67). After provocative tests, an isolated facet-syndrome was diagnosed in them. FJ laser denervation was performed in 2013–2016. A visual analogue pain scale (VAS), neck disability index (NDI), Macnab subjective satisfaction scale and complications were used for analyzing treatment efficacy. The follow-up dynamic observation lasted for 36 months, in average, after the surgery. Results. It has been found out that the technique of laser denervation of cervical FJ is highly effective for treating patients with an isolated facet-syndrome caused by FJ degenerative diseases. Clinical efficacy is supported by a persistent positive dynamics in terms of pain syndrome and functional status at early and late postoperative periods with low risks of perioperative complications.

Efficacy of pulsed radiofrequency in controlling pain caused by spinal disorders: a narrative review.

Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. Here, we aimed to systematically review the literature pertaining to the efficacy of PRF stimulation for managing pain associated with spinal disorders. We conducted a PubMed search for papers published until August 20, 2019, that used PRF to treat pain resulting from spinal disorders. The following inclusion criteria were applied when selecting the articles: (I) patients' pain was caused by spinal disorders; (II) PRF stimulation was applied on the spinal structure; and (III) after PRF stimulation, follow-up evaluation was performed to assess the change in pain intensity. Review articles were excluded. The primary literature search yielded 168 relevant papers. After reading their titles and abstracts and evaluating their eligibility based on the full-text articles, we finally included 59 publications in this review. The therapeutic outcomes reported in the selected studies showed that PRF is an effective treatment for cervical and lumbar radicular pain. Similarly, PRF stimulation seems to be effective for treating cervical joint (cervical facet and atlantoaxial joints) pain and lumbar facet joint pain. PRF stimulation has also resulted in positive outcomes in some studies, in which patients were treated for other disorders, including cervicogenic headache, discogenic neck pain, thoracic facet joint pain, discogenic back pain, and coccydynia. Nevertheless, there is insufficient evidence for the efficacy of PRF stimulation in these disorders. In conclusion, our review provides insights into the degree of evidence available on the effectiveness of PRF stimulation for treating pain associated with each of the spinal disorders reviewed. This information will help clinicians make informed decisions on using PRF stimulation to treat various spinal conditions and manage the associated pain.

Acute Cervical Facet Joint Inflammation After a Prolonged Dental Procedure: A Case Report

Background: Facet joints of the spine are the only true synovial joints between adjacent spinal levels. Degenerative disease changes of the joint, or facet arthropathy, can be asymptomatic. However, pain can occur when the joint becomes acutely inflamed. Specifically, cervical facet arthropathy and associated neck pain can be difficult to treat. Case Report: We present a case of a 64-year-old man with known lumbar spondylosis who developed acute neck pain after a dental procedure. Magnetic resonance imaging (MRI) revealed inflammation of the left C2-C3 facet joint. This patient achieved successful relief of pain with an intraarticular corticosteroid injection followed by physical therapy. Careful consideration was given to a detailed therapy protocol in order to regain pain-free active range of motion of the neck. Conclusion: To our knowledge, this is the first reported case of acute facet inflammation after a dental procedure. Additionally, this report highlights the value of intraarticular corticosteroids for an acutely inflamed facet joint. In order to prevent injury, dentists and oral surgeons should be attentive to neutral spine positioning, especially during prolonged procedures. Key words: Arthritis, cervical spine, corticosteroids, dentistry, facet joint, neck pain, physical therapy, posture

A Critical Look at the Data Supporting Ultrasound Guided Cervical Medial Branch Blocks

According to guidelines published by the American Society of Interventional Pain Physicians in 2013 ‎1, ‎2, the current evidence for cervical facet joint injections is fair. Yet the volume of these procedures continues to rise ‎3. There is a need for a more critical appraisal of the benefit, technique and adverse effects associated with cervical spine injections. The systematic review and meta-analysis by Paredes et al ‎4 seeks to better assess the evidence for use of ultrasound (US) guidance with cervical medial branch blocks. This article is also a response to a recently published critique by Schneider et al ‎5 raising concerns about the paucity of evidence evaluating the safety, accuracy, and effectiveness of US-guided cervical spine procedures.

Case-Control Comparison of Cervical Spine Radiographs From Horses With a Clinical Diagnosis of Cervical Facet Disease With Normal Horses

The accuracy of using radiographs to diagnose cervical facet osteoarthritis (CFA) in horses is undetermined. Further investigation is required to determine the clinical significance of radiographic evidence of CFA, the prevalence of radiographic changes in horses without clinical signs, and the long-term efficacy of intra-articular CFA treatment. The objectives of this study is to compare degenerative changes of the cervical facet joints of the cervical vertebrae on radiographs of horses with clinical signs of CFA with healthy cohort-matched horses, to compare clinical findings between groups, and to obtain follow-up information on the long-term outcome in treated horses. This is a retrospective case-control cohort-matched comparison study of horses treated for cervical facet disease versus horses with no clinical signs of cervical facet disease. Horses diagnosed with CFA and treated with intra-articular injection of corticosteroids were included. Follow-up information on recovery from treatment was obtained via telephone survey of owners/trainers. Healthy horses with no clinical signs of CFA were matched to treated horses by breed, sex, age, and sport as the control group. Two blinded radiologists reviewed cervical spine radiographs for each horse and recorded CFA score and intravertebral/intervertebral measurements. Clinical and radiographic parameters were compared between treatment and control groups. There was a significant difference in CFA grades for C5-6 and C6-7 between horses with presence of clinical signs and healthy horses. However, interobserver agreement between radiologists for grading CFA was moderate and only 56% of values were identical for both observers. Atrophy of the neck was present on clinical examination in most cases in the treatment group. Dressage horses were overrepresented. Overall, 64% of horses returned to their previous level of performance after treatment. Clinical examination data collected for the treatment group were retrospective and were obtained by different clinicians. Eight owners/trainers were not able to be reached for the survey. There was a significant difference in CFA grades for C5-6 and C6-7 between horses with presence of clinical signs and healthy horses. Despite these statistical differences, the clinical diagnosis of CFA based on radiographic grading alone is questionable because of the lack of agreement between the radiologists. To strengthen the diagnosis, clinical signs of facet disease, in particular atrophy of the neck muscles, need to be present to make this diagnosis. Intra-articular corticosteroid injection was effective at allowing most treated horses to return to athletic use..

Predictive value of semi-quantitative index from F-18-fluoride PET/CT for treatment response in patients with ankylosing spondylitis

PurposeWe aimed to investigate whether the lesion-to-background ratio (LBR) of the whole spinal column in ankylosing spondylitis (AS) patients based on baseline F-18-fluoride positron emission tomography/computed tomography (PET/CT) is associated with treatment response. MethodsTwenty-eight male patients with a wide range of disease activity were included in this study. Abnormal bone metabolic lesions on baseline F-18-fluoride PET/CT were visually assessed in three areas: anterior discovertebral units (DVUs) and posterior joints (cervical, thoracic, and lumbar facet joints, costovertebral joints, and costotransverse joints) of vertebrae and sacroiliac joints of the sacrum. The highest maximum standardized uptake value (SUVmax) of lesions within each area was measured. The LBR as a semi-quantitative index was defined as SUVmax of the lesion divided by mean SUV of the L5 vertebral body. Clinical disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and treatment response was evaluated based on follow-up BASDAI score. ResultsThe median follow-up period was 4.5 years (range, 0.9–5.5). The BASDAI score significantly decreased from median 6.6 (range, 1.0–9.5) at baseline to 2.0 (range, 0.6–8.1) at follow-up (P < 0.001), and the median change in BASDAI score was -3.4 (range, -8.2–4.4). The LBR of posterior joints in the spinal column had a significant positive correlation with follow-up BASDAI score (r = 0.394, P = 0.042). ConclusionIn patients with AS, the LBR of posterior joints of the spinal column on baseline PET/CT could be considered one of the potential surrogate markers for predicting treatment response.

Update of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain from 2000 to 2018 in the US Fee-for-Service Medicare Population

Interventional techniques for managing spinal pain, from conservative modalities to surgical interventions, are thought to have been growing rapidly. Interventional techniques take center stage in managing chronic spinal pain. Specifically, facet joint interventions experienced explosive growth rates from 2000 to 2009, with a reversal of these growth patterns and in some settings, a trend of decline after 2009. The objectives of this assessment of utilization patterns include providing an update of facet joint interventions in managing chronic spinal pain in the fee-for-service (FFS) Medicare population of the United States from 2000 to 2018. The study was designed to assess utilization patterns and variables of facet joint interventions in managing chronic spinal pain from 2000 to 2018 in the FFS Medicare population in the United States. Data for the analysis were obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2018. Facet joint interventions increased 1.9% annually and 18.8% total from 2009 to 2018 per 100,000 FFS Medicare population compared with an annual increase of 17% and overall increase of 309.9% from 2000 to 2009. Lumbosacral facet joint nerve block sessions or visits decreased at an annual rate of 0.2% from 2009 to 2018, with an increase of 15.2% from 2000 to 2009. In contrast, lumbosacral facet joint neurolysis sessions increased at an annual rate of 7.4% from 2009 to 2018, and the utilization rate also increased at an annual rate of 23.0% from 2000 to 2009. The proportion of lumbar facet joint blocks sessions to lumbosacral facet joint neurolysis sessions changed from 6.7 in 2000 to 1.9 in 2018. Cervical and thoracic facet joint injections increased at an annual rate of 0.5% compared with cervicothoracic facet neurolysis sessions of 8.7% from 2009 to 2018. Cervical facet joint injections increased to 4.9% from 2009 to 2018 compared with neurolysis procedures of 112%. The proportion of cervical facet joint injection sessions to neurolysis sessions changed from 8.9 in 2000 to 2.4 in 2018. This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. The utilization data for individual states also continues to be sparse and may not be accurate. Utilization patterns of facet joint interventions increased 1.9% per 100,000 Medicare population from 2009 to 2018. This results from an annual decline of - 0.2% lumbar facet joint injection sessions but with an increase of facet joint radiofrequency sessions of 7.4%. Interventional techniques, facet joint interventions, facet joint nerve blocks, facet joint neurolysis.

Longitudinal change of cervical artificial disc motion following replacement.

We reviewed charts and radiologic studies of 30 patients operated upon by ADR with Mobi-C® in single level since 2006. All patients had healthy cervical facet joints (less than or equal to grade 1 according to grading systems for cervical facet joint degeneration) preoperatively. We assessed clinical outcomes with NDI and VAS on neck and arm over follow-up and also measured ROM at implanted segment on dynamic radiographs during follow-up. The mean follow-up period was 42.4 ± 15.9 months. We then assessed the linearity of changes in ROM at implanted segment through linear mixed model. All patients showed significantly improved clinical outcomes. ROMs at implanted segment were maintained at slightly increased levels until 24 months postoperatively (P = 0.529). However, after 24 months, ROMs at implanted segment decreased significantly until last follow-up (P = 0.001). In addition, the decreasing pattern after 24 months showed a regular regression (P = 0.001). This decline was correlated with decline of extension angle at implanted segment. Based on this regular regression, we estimated that ROMs at implanted segments would be less than 2 degrees at 10.24 years postoperatively. Even though implanted segment maintains its motion for some length of time, we could assume that an artificial disc would have limited life expectancy correlated with the decline of extension angle.

Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses.

To determine the safety and efficacy of caudal cervical articular process joint arthroscopy by using needle arthroscopy in standing sedated horses. Prospective experimental case series. Six adult horses. Three horses underwent exploration of bilateral C5-6 vertebral articular process joints and three bilateral C6-7 articular process joints by using a 1.2 × 65-mm needle arthroscope under standing sedation. The 16-gauge arthroscopic trocar and canula assembly was inserted in the desired articular process joint under ultrasonographic guidance without distention of the joint. All 12 articular process joints were successfully explored. Entering the joint on the first attempt was achieved in 10 of 12 joints. A craniodorsal approach for arthroscope insertion allowed evaluation of the most cranial aspect of the articular cartilage surface. Triangulation with a spinal needle was determined to be difficult and resulted in a limited space for movement. Needle arthroscopy of the caudal cervical facet joints was performed safely and efficiently in standing sedated horses. Standing cervical articular process needle arthroscopy is a minimal morbidity technique with the potential to be an advantageous technique for the diagnosis and treatment of cervical articular process pathology.

Comparison of cervical medial branch nerve block versus trigger point injection in patients with chronic neck pain

Background: Annual prevalence of chronic neck pain in general population averages between 30%-50%. Among various causes of chronic neck pain cervical facet joint involvement accounts for about 54% to 67%. Interventional procedures such as medial branch nerve block, trigger point injections and dry needling have been described for management of chronic neck pain. Objectives: To determine the clinical effectiveness of cervical medial branch block and trigger point injections in the management chronic neck pain. Design: Randomized, double blinded, prospective study conducted at two different centers in India, Pain Clinic, Department of Anaesthesiology, J.N. Medical College hospital, Aligarh Muslim University, Aligarh, Delhi Pain management centre, New Delhi, India. Methods: Data analysis was done from a total of 60 patients with 30 patients in each group. Group CMB received cervical medial branch block and group TP received trigger point injection with levobupivacaine (0.25%) and triamcinolone (20mg) at two different levels. There was no sham group. Outcome Measure: Numeric rating scale (NRS), Neck Pain Disability Index (NDI), weekly analgesic requirement and subjective evaluation of patients was done at 1st week, 3rd week, 6th week and 12th week of follow up and compared with the pre-procedure value. Results: Significant pain relief was observed in both the groups of study, at 1st week of study, compared to baseline. Further follow up showed significantly better pain relief in patients receiving medial branch nerve block than patient receiving tender point injections at 3rd, 6th week and 12th week. NDI score in-group CMB was significantly better as compared to group TP at 3rd, 6th and 12th week follow up. Subjective evaluation of pain showed significantly greater proportion of patient with good to excellent pain relief in group receiving medial branch block. Analgesic requirement was significantly less in group CMB compared to group TP during follow up. Conclusion: Cervical medial branch block with local anaesthetic and steroid may provide long-term relief in patients with chronic neck pain than trigger point injection with no major incidence of complications in either group.

Efficacy of spinal chiropractic manipulative therapy for adjusting the relationship between cervical facet joints to treat headache caused by acute mountain sickness.

ObjectiveTo investigate the effect of spinal chiropractic manipulative therapy (SCMT) on the management of acute mountain sickness (AMS)-induced headache.MethodsOne hundred individuals who traveled to Tibet between June and October 2015 were randomized to SCMT and standard AMS pain control groups. The primary endpoints were headache and vertigo improvement.ResultsThere were 58 men and 42 women (mean age, 39.3 ± 11.1 years) with no significant differences in sex and age between the SCMT and control groups. However, a history of both headache and hypertension was higher in the controls. The two groups showed significantly improved visual analog scale (VAS) pain scores at 10 minutes, 30 minutes, and 24 hours after treatment compared with baseline. The SCMT group showed higher baseline VAS scores compared with controls, but lower VAS scores at 30 minutes. Improvements were also noted in dizziness, blood pressure, and oxygen saturation. There were no adverse events.ConclusionsSCMT can be used to relieve AMS-induced headache, dizziness, blood pressure, and oxygen saturation of people traveling rapidly to high altitudes, but the symptoms were only evaluated for 24 hours. SCMT may be suitable for the management of AMS for patients who want to avoid drugs and oxygen inhalation.

The Effectiveness of Pulsed Radiofrequency on Joint Pain: A Narrative Review.

Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. We reviewed the literature on the efficacy of PRF for controlling pain in joint disorders. We searched PubMed for papers published prior to September 7, 2019, that used PRF to treat pain due to joint disorders. The key search phrases for identifying potentially relevant articles were (PRF AND joint) OR (PRF AND arthritis) OR (PRF AND arthropathy). The following inclusion criteria were applied for the selection of articles: (1) patients' pain was caused by joint disorders; (2) PRF stimulation was applied to manage joint-origin pain; and (3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain intensity. Moreover, joints with more than 3 reported PRF studies were included in our review. The primary literature search yielded 141 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included 34 publications in this review. Based on the positive therapeutic outcomes of previous studies, PRF stimulation seems to be an effective treatment for cervical and lumbar facet, sacroiliac, knee, and glenohumeral joint pain. PRF appears to be beneficial. For confirmation of the effectiveness of PRF on joint pain, more high-quality studies are needed. Our review provides insights on the degree of evidence according to pain in each joint, which will help clinicians make informed decisions for using PRF stimulation in various joint pain conditions.