1. 2012;15;E839-E868Systematic Review of the Therapeutic Effectiveness of Cervical Facet Joint Interventions: An Update
   Systematic Review
   Mark V. Boswell, MD, PhD, Sanjeeva Gupta, MD, Standiford Helm II, MD, Stephen P. Ward, MD, Nalini Sehgal, MD, Ramsin M. Benyamin, MD, Vijay Singh, MD, Sairam Atluri, MD, David A. Bryce, MD, Stephanie Geffert, MLIS, Bradley W. Wargo, DO, Frank J.E. Falco, MD, Laxmaiah Manchikanti, MD, and Sukdeb Datta, MD.

BACKGROUND:  The prevalence of chronic, recurrent neck pain is approximately 15% 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, when disc herniation, radiculitis, and discogenic are not pathognomic. 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:   Systematic review of therapeutic cervical facet joint interventions. 

OBJECTIVE:  To determine and update the clinical utility of therapeutic cervical facet joint interventions in the management of chronic neck pain.

METHODS:  The available literature for utility of facet joint interventions in therapeutic management of cervical facet joint pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies.

The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles.

OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.

RESULTS:  In this systematic review, 32 manuscripts were considered for inclusion. For final analysis, 4 randomized trials and 6 observational studies met the inclusion criteria and were included in the evidence synthesis. Based on one randomized, sham-controlled, double-blind trial and 5 observational studies, the indicated evidence for cervical radiofrequency neurotomy is fair. Based on one randomized, double-blind, active-controlled trial and one prospective evaluation, the indicated evidence for cervical medial branch blocks is fair. Based on 2 randomized controlled trials, the evidence for cervical intraarticular injections is limited.

LIMITATIONS:  Paucity of the overall published literature and specifically lack of literature for intraarticular cervical facet joint injections.

CONCLUSIONS:  The indicated evidence for cervical radiofrequency neurotomy is fair. The indicated evidence for cervical medial branch blocks is fair. The indicated evidence for cervical intraarticular injections with local anesthetic and steroids is limited.