PMID- 19305483
OWN - NLM
STAT- MEDLINE
DCOM- 20090724
LR  - 20220408
IS  - 1533-3159 (Print)
IS  - 1533-3159 (Linking)
VI  - 12
IP  - 2
DP  - 2009 Mar-Apr
TI  - Systematic review of diagnostic utility and therapeutic effectiveness of cervical 
      facet joint interventions.
PG  - 323-44
AB  - 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% to 63% 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 literature from 1966 through December 2008 in the 
      English language. A review of the literature of the utility of facet joint 
      interventions in diagnosing and managing facet 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 and the 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 relief greater 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 evidence for 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 lacking for intraarticular 
      injections. LIMITATIONS: A systematic review of cervical facet joint 
      interventions is hindered by the paucity of published literature and lack of 
      literature for intraarticular cervical facet joint injections. 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.
FAU - Falco, Frank J E
AU  - Falco FJ
AD  - Mid Atlantic Spine & Pain Specialists, Newark, DE 19713, USA. cssm01@aol.com
FAU - Erhart, Stephanie
AU  - Erhart S
FAU - Wargo, Bradley W
AU  - Wargo BW
FAU - Bryce, David A
AU  - Bryce DA
FAU - Atluri, Sairam
AU  - Atluri S
FAU - Datta, Sukdeb
AU  - Datta S
FAU - Hayek, Salim M
AU  - Hayek SM
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
SB  - IM
MH  - *Anesthesia, Local
MH  - Cervical Vertebrae
MH  - Chronic Disease
MH  - Evidence-Based Medicine
MH  - Humans
MH  - Injections, Intra-Articular
MH  - Neck Pain/*drug therapy/physiopathology
MH  - *Nerve Block/methods
MH  - Pain Measurement/methods
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - Zygapophyseal Joint/*drug effects
RF  - 147
EDAT- 2009/03/24 09:00
MHDA- 2009/07/25 09:00
CRDT- 2009/03/24 09:00
PHST- 2009/03/24 09:00 [entrez]
PHST- 2009/03/24 09:00 [pubmed]
PHST- 2009/07/25 09:00 [medline]
PST - ppublish
SO  - Pain Physician. 2009 Mar-Apr;12(2):323-44.