Cervical Facet Syndrome: Cervical Medial Branch Block and Radiofrequency Ablation

  • Samer N. Narouze
  • Jan Van Zundert
  • Maarten Van KleefEmail author


Neck pain is defined as pain in the area between the base of the skull and the first thoracic vertebra. Pain into adjacent regions is defined as radiating neck pain. Pain may radiate into the head (cervicogenic headache), shoulder, or upper arm (radicular or non-radicular pain). Neck pain is common in the general population. The 1-year prevalence varies between 30 and 50 %. It is more common in women with peak prevalence in middle age. Risk factors include genetic predisposition and smoking.

The following innervated structures in the neck can be a source of pain: vertebrae, discs, uncovertebral (Luschka) joints, ligaments, muscles, and facet (zygapophyseal) joints. Knowledge of the innervation of various structures in the neck is important for the interpretation of diagnostic blocks and deciding on target-specific interventional treatment.


Neck Pain Facet Joint Whiplash Injury Medial Branch Cervicogenic Headache 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Guzman J, Hurwitz EL, Carroll LJ, et al. A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:S14–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:S39–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Bogduk N, McGuirk B. Management of acute and chronic neck pain, Pain research and clinical management. Edinburgh/New York: Elsevier; 2006.Google Scholar
  4. 4.
    Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004;5:15.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Yin W, Bogduk N. The nature of neck pain in a private pain clinic in the United States. Pain Med. 2008;9:196–203.PubMedCrossRefGoogle Scholar
  6. 6.
    Pal GP, Routal RV, Saggu SK. The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region. J Anat. 2001;198:431–41.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Yoganandan N, Knowles SA, Maiman DJ, Pintar FA. Anatomic study of the morphology of human cervical facet joint. Spine. 2003;28:2317–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine. 1982;7:319–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Lord SM, Barnsley L, Bogduk N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Neurosurgery. 1995;36:732–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Teo EC, Ng HW. Evaluation of the role of ligaments, facets and disc nucleus in lower cervical spine under compression and sagittal moments using finite element method. Med Eng Phys. 2001;23:155–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63:278–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Zdeblick TA, Abitbol JJ, Kunz DN, McCabe RP, Garfin S. Cervical stability after sequential capsule resection. Spine. 1993;18:2005–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004;29:390–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Winkelstein BA, McLendon RE, Barbir A, Myers BS. An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area. J Anat. 2001;198:455–61.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine. 2001;26:2095–101.PubMedCrossRefGoogle Scholar
  16. 16.
    Kallakuri S, Singh A, Chen C, Cavanaugh JM. Demonstration of substance P, calcitonin gene-related peptide, and protein gene product 9.5 containing nerve fibers in human cervical facet joint capsules. Spine. 2004;29:1182–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Kettler A, Werner K, Wilke HJ. Morphological changes of cervical facet joints in elderly individuals. Eur Spine J. 2007;18:987–92.CrossRefGoogle Scholar
  18. 18.
    Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: a study in normal volunteers. Spine. 1990;15:453–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Cohen SP, Bajwa ZH, Kraemer JJ, et al. Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis. Reg Anesth Pain Med. 2007;32:495–503.PubMedGoogle Scholar
  20. 20.
    Friedenberg ZB, Miller WT. Degenerative disc disease of the cervical spine. J Bone Joint Surg Am. 1963;45:1171–8.PubMedGoogle Scholar
  21. 21.
    Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.CrossRefGoogle Scholar
  22. 22.
    van Suijlekom H, Van Zundert J, Narouze S, van Kleef M, Mekhail N. Evidence-based interventional pain medicine according to clinical diagnoses: cervicogenic headache. Pain Pract. 2010;10(2):124–30.PubMedCrossRefGoogle Scholar
  23. 23.
    van Eerd M, Patijn J, Lataster A, Rosenquist RW, van Kleef M, Mekhail N, Van Zundert J. Evidence-based interventional pain medicine according to clinical diagnoses: cervical facet pain. Pain Pract. 2010;10(2):113–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. 1993;55:99–106.PubMedCrossRefGoogle Scholar
  25. 25.
    Bogduk N, Holmes S. Controlled zygapophysial joint blocks: the travesty of cost-effectiveness. Pain Med. 2000;1:24–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Barnsley L, Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. 1993;18:343–50.PubMedGoogle Scholar
  27. 27.
    Manchikanti L, Singh V, Falco FJ, Cash KM, Fellows B. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine. 2008;33:1813–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Hove B, Gyldensted C. Cervical analgesic facet joint arthrography. Neuroradiology. 1990;32:456–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intra-articular corticosteroids for chronic pain in the cervical zygapophysial joints. N Engl J Med. 1994;330:1047–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, Peloso P, Holm LW, Côté P, Hogg-Johnson S, van der Velde G, Cassidy JD, Haldeman S. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:S153–69.PubMedCrossRefGoogle Scholar
  31. 31.
    Geurts JW, van Wijk RM, Stolker RJ, Groen GJ. Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Reg Anesth Pain Med. 2001;26:394–400.PubMedGoogle Scholar
  32. 32.
    Niemisto L, Kalso E, Malmivaara A, Seitsalo S, Hurri H. Radiofrequency denervation for neck and back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine. 2003;28:1877–88.PubMedCrossRefGoogle Scholar
  33. 33.
    Manchikanti L, Singh V, Vilims BD, Hansen HC, Schultz DM, Kloth DS. Medial branch neurotomy in management of chronic spinal pain: systematic review of the evidence. Pain Physician. 2002;5:405–18.PubMedGoogle Scholar
  34. 34.
    Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10:7–111.PubMedGoogle Scholar
  35. 35.
    Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335:1721–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Husted DS, Orton D, Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain. J Spinal Disord Tech. 2008;21:406–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Narouze SN. Ultrasound-guided cervical spine injections: ultrasound “prevents” whereas contrast fluoroscopy “detects” intravascular injections. Reg Anesth Pain Med. 2012;37(2):127–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Heckmann JG, Maihofner C, Lanz S, Rauch C, Neundorfer B. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance. Clin Neurol Neurosurg. 2006;108:709–11.PubMedCrossRefGoogle Scholar
  39. 39.
    Verrills P, Mitchell B, Vivian D, Nowesenitz G, Lovell B, Sinclair C. The incidence of intravascular penetration in medial branch blocks: cervical, thoracic, and lumbar spines. Spine. 2008;33:E174–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Cohen SP, Strassels SA, Kurihara C, Forsythe A, Buckenmaier CC, McLean B, Riedy G, Seltzer S. Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology. 2010;112:144–52.PubMedCrossRefGoogle Scholar
  41. 41.
    Narouze S. Complications of head and neck procedures. Tech Reg Anesth Pain Manag. 2007;11(3):171–7.CrossRefGoogle Scholar
  42. 42.
    Michel-Batot C, Dintinger H, Blum A, et al. A particular form of septic arthritis: septic arthritis of facet joint. Joint Bone Spine. 2008;75:78–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–53.PubMedGoogle Scholar
  44. 44.
    Haspeslagh SR, Van Suijlekom HA, Lame IE, Kessels AG, van Kleef M, Weber WE. Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684]. BMC Anesthesiol. 2006;16:1.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Samer N. Narouze
    • 1
  • Jan Van Zundert
    • 2
    • 3
  • Maarten Van Kleef
    • 4
    Email author
  1. 1.Center for Pain Medicine, Western Reserve HospitalCuyahoga FallsUSA
  2. 2.Multidisciplinary Pain Center, Ziekenhuis Oost-LimburgGenkBelgium
  3. 3.Department of Anesthesiology and Pain ManagementMaastricht University Medical CenterMaastrichtThe Netherlands
  4. 4.Department of Anesthesiology and Pain ManagementUniversity Hospital MaastrichtMaastrichtThe Netherlands

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