1. 2003;6;411-418Electrical Stimulation Induced Cervical Medial Branch Referral Patterns
   An Original Contribution
   Robert E. Windsor, MD, Diwakar Nagula, DO, Seneca Storm, MD, Anthony Overton, DO, and Scott Jahnke, DO.

Study Design: Electrical stimulation of the right cervical medial branches with or without the third occipital nerves was performed in nine subjects for a total of forty-eight medial branches and eight third occipital nerves. The referral patterns of each nerve or nerve branch was mapped on a human line diagram. These diagrams were compared to facet joint (zygapophyseal joint, facet joint), myofascial, and discogenic referral patterns already published by various authors.

Objective: To determine the referral patterns of the cervical medial branches and the third occipital nerve.

Hypothesis: The cervical medial branch referral patterns created by electrical stimulation may differ from those reported from other etiologies and may prove to be useful when considering various cervical pain syndromes.

Methods: The third occipital nerve and third through eighth medial branches of the cervical posterior rami of nine subjects with and without a history of neck pain were electrically stimulated under fluoroscopic imaging. All subjects were blinded to the level of stimulation, and the referral patterns of each individual were mapped out on a human line drawing by the primary author of this study. These referral patterns were compared to referral patterns reported from other etiologies by various authors.

Conclusions: Electrical stimulation of the third occipital nerve as well as the medial branch of the right C3-C8 posterior primary rami create discrete, reproducible referral patterns which differ from those reported from other etiologies by various authors.

Keywords: Zygapophyseal joint, facet joint, medial branch, referral pattern, myofascial pain, headaches, discogeni