Diagnostic Cervical Zygapophysial Joint Blocks for Chronic Cervical Pain

Abstract

AbstractObjectives.(1) To determine the prevalence of cervical zygapophysial joint pain in a specialist clinical setting. (2) To review the number of diagnostic blocks needed to identify the segmental level of the symptomatic joints. (3) To determine the distribution of segmental levels of cervical zygapophysial joint pain in a clinical setting. Design and Setting.Data was retrospectively gathered on ninety-seven patients aged 18 to 82 years with chronic cervical pain (with or without headache) of more than six months duration, referred to three independent Rehabilitation Medicine specialists in their hospital outpatient clinics and private rooms. Intervention.Diagnostic fluoroscopic cervical third occipital and medial branch blocks of their zygapophysial joints. Results.On a worst case analysis 35 of 97 (36%) of the subjects were found to have a symptomatic cervical zygapophysial joint (Confidence Interval: 27%-45%). The most common symptomatic levels were C3/4 (11 of 35; 31%) and C5/6 (10 of 35; 29%). The symptomatic segmental level was found at the first attempt by reference to a standard pain diagram in 83% (29 of 35) of cases. Conclusion.The prevalence rate in this clinical study is consistent with that found in previous studies in a research setting. In a conventional clinical setting zygapophysial joints are a common source of pain in patients presenting with chronic neck pain, with or without headache, and this is readily diagnosable. Diagnosis by zygapophysial joint injections allows these patients to consider the treatment of radio frequency neurotomy.Key Words: Cervical spinecervical zygapophysial joint painwhiplash