1. 2018;21;E661-E665Fluoroscopically-Guided Cervical Zygapophyseal Therapeutic Joint Injections May Reduce the Need for Radiofrequency
   Observational Study
   David W. Lee, MD, and Christopher Huston, MD.

BACKGROUND: There is a paucity of literature studying therapeutic intraarticular zygapophyseal (commonly referred to as facet) joint injections in the atraumatic patient population. As a result of this, intraarticular injections have been dismissed as a possible treatment for cervical zygapophyseal joint-mediated pain. Radiofrequency neurotomy (RFN) is currently the accepted treatment for facet joint neck pain.

OBJECTIVE: This prospective observational study investigated injection response in an atraumatic population to determine treatment viability and whether injections reduce the need for RFN in neck pain patients.

STUDY DESIGN: Observational case series study.

SETTING: This study took place in the outpatient clinic of a private practice.

METHODS: The double-block paradigm (DBP) was used to determine if symptoms were zygapophyseal joint-mediated. Lidocaine and bupivacaine diagnostic injections were used. Participants passing the DBP underwent fluoroscopically-guided cervical zygapophyseal joint injections (betamethasone and 1% lidocaine) and 1 year of follow-up. Outcomes were a Verbal Numeric Scale score (VNS) > 2, 50% decrease in VNS, patient-reported improvement, and opioid use at the 1-year follow-up.

RESULTS: One hundred and eighteen patients were enrolled; 51 passed the DBP. These 51 patients underwent injections. Forty-four patients (59 joints) were surveyed 1 year later with 7 follow-up losses. Thirty-four of 59 joints showed >/= 2-point VNS reductions or >/= 50% overall symptomatic improvement after 1 year. Twenty-four of 44 ceased narcotics use.

LIMITATIONS: The limitations of this research included the lack of randomization and blinding, smaller sample size, and reliance on subjective reporting from the participants both immediately after the procedures and at follow-up. As this was a prospective observational study, there is the possibility of unintended bias by both patients as well as the authors.

CONCLUSION: Cervical zygapophyseal joint injections may reduce the need for RFN; additional studies are required.

KEY WORDS: Neck pain, facet joint, cervical zygapophyseal joint injections, radiofrequency neurotomy