Artikel
Cervical Facet-joint syndrome – Value of diagnostic infiltration and therapeutic denervation according to a monocentric analysis
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Veröffentlicht: | 21. Mai 2013 |
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Objective: Cervical facet-joint syndrome is an important differential diagnosis in patients with chronic neck pain, a disease entity with high prevalence. Therapeutic approaches outside ACDF include escalation regimens such as diagnostic facet-joint blocks, as well as therapeutic denervations. The purpose of this retrospective, monocentric analysis was to characterize both the diagnostic yield of prespecified inclusion and exclusion criteria (non-specific, refractory neck pain without radicular pain, absence of intraspinal pathology and exacerbation on rotation and extension among others) as well as the efficacy and predictive value of facet-joint blocks for successful denervations.
Method: We reviewed the data of 79 patients undergoing diagnostic facet-joint infiltration and consecutive denervation (n=31, for patients with improvement >50% after infiltration) between 2004 and 2009 at our institution. Data collection included prospectively collected pre- and postoperative questionnaires and follow-up evaluations chart as well as telephone interviews, addressing symptoms, duration and localization, current VAS, pain medication, neurological status and overall perceived improvement. Type of previous surgery as well as localization of infiltration or denervation were also recorded.
Results: In compliance with our inclusion and exclusion criteria, moderate improvement (>50%) was noted in 70.7% of patients (>70% improvement in 51.4%) for 39.9d (±113.1). Preexistent neck, arm and shoulder pain and headache responded significantly to infiltration according to VAS score (p<0.001). Success rate was not influenced by previous surgery, relation to fusion (cranial vs caudal), number of levels treated (≤2 vs >2 segments), duration of symptoms (<1yr vs >1yr) or previous opioid treatment. Though the data set available is limited, initial improvement in excess of 70% seemed to respond significantly better to thermodenervation than moderate improvement of 50–70% (p<0.01).
Conclusions: Facet joint infiltrations may provide significant relief in selected patients with chronic neck pain, independent from symptom duration, opioid use or previous surgery. If initial improvement exceeds 70%, thermodenervation may provide comparable, likely more durable symptom control.