Group 1

Summary
Cervical Facet Joint

CERVICAL FACET JOINT:

Facet joint (also known as zygapophyseal, are synovial joint between the vertebrae of spines,
There are two facet joints (left and right) in each spinal motion segments.

Biomechanically, functions of each pair of facet joint are to guide and limited movement of
that spinal motion segments.

Every section of spine has facet joint. You may heared about referred to as cervical facet joint
(neck), thoracic facet joint (mid back) and lumbar facet joint (low back).

Disorder is hypothesized to obtain from trauma of the cervical facet joints. The face joints
have recently been considered a source of spinal pain since the early 1900 s. The purpose of
this article was heading to review the relevant literature on cervical facet joint dysfunction
and determine findings regarding its ,etiology, prevalence, clinical features, diagnosis, and
treatment.

METHODS

Several databases was performed including Medline (1966 to present), Ovid (1966 to present), and
the Cochrane {data source } (1993 to present), using the key words cervical, neck pain, and arthritis.
In addition, we examined the recommendations cited in these articles for key words. Chosen articles
were critically examined and had the subsequent criteria: (1) all articles studied some facet of
cervical facet joint pain--anatomy, prevalence, etiology, diagnosis, treatment; (2) only full, released
articles were studied, not abstracts; and (3) all articles were released in English.

RESULTS

We all examined 46 references that consisted of 45 record articles and relevant areas from 1
textbook. The {diary|record|log} articles included randomized controled trials (RCTs), meta analyses,
uncontrolled clinical trials, out of control comparison studies, nonquantitative reviews, and
literature based reviews.

DISCUSSION

Pathophysiology

The cervical facet joints are diarthrodial joints formed by the articulation of the superior articular
process (SAP) with the corresponding substandard articular process of the cephalad vertebrae. The
inferior articular process arise from the{horizontal|extensive} mass of the backbone, which {is|is
created} at the junction of the and pedicle. In the upper-cervical spine the {facet joints with an
angle approximately 45 superior to thetransverse planes and {little by little|slowly but surely}
assume {a far more|an even more|a much more} vertical position as they descend to the thoracic
region and a separate branch arising from the foundation of the {socializing} branch or from the
communicating branch itself. The upper-cervical synovial joints (the atlanto-occipital and atlanto-
axial joints certainly not are generally not} innervated by cervical dorsal rami but by branches of the
C1 and C2 ventral rami. Cervical facet joint pain comes from either degenerative processes. Studies
have found that facet on your arthritis is often found with disk degeneration but that disk
degeneration can frequently be found without facet arthritis. In addition, 1 study found {it may|it
will} take 20 or more years to develop facet joint arthritis after starting point of disk degeneration.
12-15, 16 Nevertheless other MRI studies of the back spine have failed to show a correlation
between degenerative disks and {facet|feature} joint arthritis {and also have|and possess|and still
have} even found evidence of facet joint damage without degeneration

Prevalence

Research have shown a large variability in the frequenc ofcervical facet joint pain. 318 patients with
intractable neck pain once they underwent either single facet joint shots, provocation
diskography,or both. They estimated that the prevalence of facet on your pain in this populace
human population was inhabitants at least 25% but could be as high as63%, the patients who went
only provocation diskographyalso received facet joint shots. Yet Barnsleyet al19 described a more
specific double-blind, double-blockparadigm in which the medial divisions of patients with long-term
neck pain were using 2 local anesthetics with differentdurations of action: 2% lidocaine and 0. 5%
bupivacaine. Theresponses to the 2 injections were compared, and a patient was considered a true
positive if the duration of pain relief was longer with the bupivacaine than the lidocaine. With this
randomized, trial, 34 of 44 patients had {much longer for a longer time pain relief with bupivacaine
than lidocaine (P_. 002), leadingthe researchers to conclude that the double-block paradigm was a
valid diagnostic method toidentify painful cervical facet{bones|joint parts|joint capsules.
Subsequent studies20-22 using this method have estimatedthe prevalence of cervical facet joint pain
to vary from range between from 36% to 55% and also have found a false-positive rate with
singlediagnostic to be 27% to 66%. Although the doubleblockparadigm has shown a higher
specificity with lowerfalse-positive results, Lord et al23 showed {that whenever|that after}
thesepatients are given {another|a 3rd|one third} placebo injection using normal saline,this method
{produces|brings|makes} {a lesser|a reduced} sensitivity (54%) with higher falsenegativeresults. In
whiplash disorders, the double-block paradigmalone had a prevalence of 54%, twenty four but when
adding aplacebo injection the {frequency was|occurrance was} 50% for C2-3 facet joint pain and
49% for lower-cervical {facet|feature} joint pain (overall frequency,60% for C2-3 or below).

Clinical Features

{There were|There are} no high quality studies {which may have|that contain} shown that the
{occurrence} of any particular signs or symptoms is significantly associated with cervical facet
dysfunction. The {medical|scientific|specialized medical}presentation of cervical
{facet|feature|factor} joint pain is similar to axial neckpain of other etiologies including spinal
stenosis, cervical{stress|tension|pressure}, and diskogenic pain. Cervical facet pain is often
characterizedby axial {neck of the guitar|side|associated with the guitar} pain, which may
{expand|portray} suboccipitallyto the {shoulder blades|shoulder muscles|neck} or midback. Often
there is a previous {background|record}of hyperextension injury to the neck or other trauma. Based
onstudies in which joints were injected with contrast medium inasymptomatic patients or treated
with medial {department|part|office} blocks insymptomatic patients, composite maps were created
showingthat each joint produces a distinct {known|referenced|called} pain pattern. 26-28Fukui et
al29 injected {comparison|distinction|compare} medium into the {important joints|bones|joint
parts} of sixty one{systematic|characteristic} patients and subsequently performed facet
denervationon patients whose pain was produced by the injection.During both the injection of the
contrast medium and the facet denervation, patients were asked to statement if their usual pain was
reproduced of their pain based on10 discovered. study findings were similar to the results {present
in the previous studies on pain habits .To our knowledge, there are no physical examination
maneuversthat are specific for the associated with cervical facet joint dysfunction. compared the
accuracy and reliability of manual diagnosis by a trained manipulative specialist to radiologically
controlled nerve blocks on 20 patients. Based on such as abnormal end-feel or resistance at the
extremesof the range of motion and this study found that sensitivity was. 89 and specificity was. 47
for these manual diagnostic techniques and therefore refutes the results of the study that showed
{totally|completely|fully}sensitivity and specificity. The results of this should be with caution
because only 1 clinician examinedthe patients, only those patients with positive clinical{results
were|conclusions were|studies were} given the analysis and neither the clinicians nor patients
included were blinded to the results of the examination.

Diagnostic Workup

There are a number of different tests used to assist in the analysis of cervical facet joint pain.
Workup often withplain radiographs, which are a good for detecting instability, fractures, abnormal
lesions, and osteoarthritis. If radiographs are ordered, they should include flexion and/orextension
views to any irregular vertebral motion or spine instability, as well as a trauma and/or a dens
fracture. Advanced imaging such as CT orMRI can even used to diagnose causes of cervical facet joint
pain. Patients who received a facet injection in the setting of a positive SPECT scan werevery likely to
have significant improvement in pain and function scores at 1 and 3 weeks follow-up. In addition,
thenumber of facets was reduced in the SPECT-positive patients, and then the cost was reduced
from $2191 to$1865 the patient. To our knowledge, no studies exist that evaluate SPECT in figuring
out the diagnosis of} cervical facet joint {disorder|malfunction|problems} or inpredicting the
response to cervical facet joint injection

Treatment

Conventional management of cervical facet joint dysfunctionand other mechanical neck disorders
usually involves a trial of analgesic and anti-inflammatory medications, physical therapy(PT), various
modalities (eg, heat and ice, massage, transcutaneouselectric nerve stimulation, traction, orthoses),
andspinal manipulation or mobilization. Based on our review, nostudies were found that specifically
these treatmen toptions in relation to cervical facet joint dysfunction. With specific treatment of
this condition, only intra-articular facetinjections and radiofrequency (RF) neurotomy were
determined. Injections. Therapeutic cervical facet joint injections with steroidal drugs may be
performed under fluoroscopic guidance,either immediately into the synovial joint (intra-articular
block) or within the medial branch of the dorsal rami above and under the affected joint (medial
branch block). {The two|Equally|Both equally} injections {attain|complete}the same goal of blocking
pain impulses {received from|provided by|from}the facet joint. Depending on anatomic studies it
has been recommended that medial branch obstructions have the same specificity as intra articular
blocks, but no studies comparing these 2 types of shots in the cervical spinal vertebrae exists. 2, 8
Intra-articular and the needle into the epiduralspace, intervertebralforamen, or vertebral artery.
Barnsleyet al39 performed a randomized, double-blind trial in 41 patientswith chronic neck pain,
contrasting the result of intraarticularinjections with betamethasone compared to 0. 5%
bupivacaine. Much less, Significantly less} than half of the patients reported pain alleviation formore
than one particular week, and fewer than 20% had treatment for more than 1 month, regardless of
the treatment received. Structured on these results, Patients with cervical facet joint pain in the
group had significantly longer pain relief than those in the groups. Even though both ofthese studies
concluded that intra-articular cervical facet joint injections were effective, their results have a great
potential for selection bias and false-positives because they were not RCTs.

CONCLUSIONS

Fibrous capsule; they contains articular cartilage and menisci and are innervated by the medial
branches of the dorsal rami. Discomfort from the cervical joints can originate from traumatic
hyperextension injuries such as whiplash or pathological processes such as osteoarthritis.The clinical
features of this condition resemble other causes of axial pain, and differential diagnosis includes
cervical, spinal stenosis, and diskogenic pain. Thediagnostic workup usually {commences} with
radiographs to ruleaway fracture or instability, but advanced imaging such as CT orMRI can be handy
if the diagnosis is uncertain. A few studiesof patients with lumbar facet pain suggest that SPECT can
be used to predict which patients are good individuals for intraarticularfacet joint injections; there
are no high quality SPECT check out search within studies involving cervical facet dysfunction.
Limited evidence is present concerning treatment of cervicalfacet joint dysfunction. Restorative
cervical facet injectionscan be performed through intra-articular blocks or medial{department part
blocks. Limited studies on intra-articular blocks givedisagreeing evidence regarding their
performance; there were no studies {located on the long-term efficacy of medial branch blocks only.
RF neurotomy through a continuous or pulsed strategy has been shown through limited studies to
provide lasting pain relief from cervical facet joint disorder for several months. Little studies were
found that analyzed the efficacy of conservative management in cervical facet dysfunction,
REHABILITATION, modalities, spinal manipulation or mobilization).