A 65-Year-Old Man with Chronic Neck Pain (Cervical Facet Disease)

Abstract

Cervical facet disease (aka cervical facet syndrome) is often one of exclusion. This disease implies axial pain from involvement of the posterior spinal column elements. Degenerative changes have been well documented in the literature. The facet joint is a structure which resists compression at higher loads, anterior shear, extension, lateral bending, and torsion (Sial et al., Waldman pain management, 2011). The structure and function of the spine give the trunk of the body stability and mobility, both of which are mediated largely by the zygapophysial joints (facets). The cervical spine is the most mobile of the spinal regions because of its articular shapes and orientations, and laxity of its joint capsules. Active movements of the cervical spine have been measured as up to 70 degrees each of extension and flexion with radiographic study, about 45 degrees of side bending and up to 40 degrees of rotation in either direction (Johnson et al., J Bone Joint Surg Am 59A:332–339, 1977; Alund and Larsson, Spine 15:87–91, 1990). Stability is provided in the cervical spine by the shape of the vertebral processes: the uncinate processes prevent lateral translation and limit side bending; spinous processes limit extension. Further stability is provided by spinal ligaments, the anterior longitudinal ligament, and the posterior longitudinal ligament, ligament flavum, and ligament nuchae (King and Borowczyk, Pain procedures in clinical practice, 2011). Facet joint pain results in referral patterns to the head, shoulders, and upper extremities. Both the synovium and capsule of each facet are richly supplied with nociceptor terminals. Medial branches innervate these facet joints sending afferent pain signals by way of A, D, and C fibers to higher cortical regions.