title: Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions.
abstract: BACKGROUND
  Chronic, recurrent neck pain is common and is associated with high pain intensity and disability, which is seen in 14% 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. 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.
  
  
  METHODS
  A systematic review of cervical facet joint interventions.
  
  
  OBJECTIVE
  To evaluate the accuracy of diagnostic facet joint nerve blocks and the effectiveness of cervical facet joint interventions.
  
  
  METHODS
  Medical databases and journals were searched to locate all relevant literature from 1966 through December 2008 in the English language. A review of the literature of the utility of facet joint interventions in diagnosing and managing facet joint pain was performed according to the Agency for Healthcare Research and Quality (AHRQ) criteria for diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials.
  
  
  METHODS
  The level of evidence was defined as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
  
  
  METHODS
  For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks which achieve at minimum 80% relief of pain and the ability to perform previously painful movements. For therapeutic interventions, the primary outcome measure was pain relief (short-term relief up to 6 months and long-term relief greater than 6 months) with secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake.
  
  
  RESULTS
  Based on the utilization of controlled comparative local anesthetic blocks, the evidence for the diagnosis of cervical facet joint pain is Level I or II-1. The indicated evidence for therapeutic cervical medial branch blocks is Level II-1. The indicated evidence for radiofrequency neurotomy in the cervical spine is Level II-1 or II-2, whereas the evidence is lacking for intraarticular injections.
  
  
  CONCLUSIONS
  A systematic review of cervical facet joint interventions is hindered by the paucity of published literature and lack of literature for intraarticular cervical facet joint injections.
  
  
  CONCLUSIONS
  The evidence for diagnosis of cervical facet joint pain with controlled comparative local anesthetic blocks is Level I or II-1. The indicated evidence for therapeutic facet joint interventions is Level II-1 for medial branch blocks, and Level II-1 or II-2 for radiofrequency neurotomy.
authors.affiliation: Mid Atlantic Spine & Pain Specialists, Newark, DE 19713, USA. cssm01@aol.com
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Falco
authors.forename: Stephanie
authors.initials: S
authors.lastname: Erhart
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Wargo
authors.forename: David A
authors.initials: DA
authors.lastname: Bryce
authors.forename: Sairam
authors.initials: S
authors.lastname: Atluri
authors.forename: Sukdeb
authors.initials: S
authors.lastname: Datta
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
mesh_terms: D000772:Anesthesia, Local; D002574:Cervical Vertebrae; D002908:Chronic Disease; D019317:Evidence-Based Medicine; D006801:Humans; D007270:Injections, Intra-Articular; D019547:Neck Pain / Q000188:drug therapy* / Q000503:physiopathology; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000187:drug effects*