A Literature Review of Cervical Facet Joint DysfunctionThe authors reviewed 45 articles and one textbook while conducting a literature review of cervical facet joint dysfunction. Cervical facet joints are joints that are formed by processes that extend from the bottom of the vertebral bone above with processes that extend from the upper portion of the vertebral bone below. They are surrounded by a fibrous capsule, are lined by synovial membranes, and contain articular cartilage and menisci. Cervical facet joint pain is generally from trauma, or degenerative changes.
Prevalence of cervical facet joint pain ranges from 25 percent to 66 percent based on diagnosis using two medial branch blocks, MBB. The first MBB is done with short-acting local anesthetic, and the second with long-acting anesthetic. Those who had a longer duration of pain relief with the long-acting anesthetic were considered being positive for facet joint dysfunction. While some researchers feel that diagnosis can be made based on physical examination, particularly by a skilled manipulative therapist, the research is not consistent.
Cervical facet syndrome is difficult to diagnose as symptoms are similar to those with spinal stenosis, cervical strain, and diskogenic pain. Cervical facet joint pain can radiate to the base of the skull, upper back and shoulders, or midback. Ten regions of referred pain from the facet joints in the cervical spine have been identified by one of the researchers are similar to results of other studies.
Imaging studies that are used to assist in the diagnosis of cervical facet joint pain usually begin with plain radiographs. Flexion and extension films to detect instability, and open mouth view to detect dens fracture are recommended. Advanced imaging such as computed tomography and magnetic resonance imaging can also be used to diagnose facet joint pain. One study showed that degenerative changes in the cervical spine found on advanced imaging were asymptomatic 75 percent of the time in patients in their seventh decade. Therefore, findings on imaging studies need to be considered based on the patient history, physical exam, and symptoms. Single-photon emission tomography, SPECT scan, while currently not recommended, may help determine which patients are good candidates for intra-articular facet joint injections. Some studies demonstrate that those patients with a positive SPECT scan were more likely to have significant improvement in pain and function short-term and long-term following facet injection. Also, fewer facets were injected, reducing the cost to the patient.
No studies were found that analyzed the benefit of conservative care such as medication, physical therapy, heat or cold, or spinal manipulation in the management of cervical facet dysfunction specifically. Cervical facet injections to include intra-articular blocks or medial branch blocks show conflicting benefit. The studies involving radio-frequency neurotomy are limited, but show that it can provide pain relief from cervical facet joint dysfunction for several months.
D. Kirpalani, R. Mitra. Cervical facet joint dysfunction: A review. Arch Phys Med Rehabil. April 2008. Volume 89. Pp. 770-774.
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