Syndromic cervical facet pain is defined by a combination of symptoms including: axial neck pain that can radiate or not past the shoulders (radicular) or the head (cervicogenic), pain with pressure on the dorsal spinal column at the level of the cervical facet joints, limitation of neck extension and rotation, and absence of neurological symptoms1.
Neck pain is the third most reported cause of musculoskeletal complaint in the general population, with a yearly prevalence ranging between 30% to 50%1. Amongst this large group of individuals who would eventually develop a chronic neck pain condition, more than 50% thereof will suffer from facet- or zygapophyseal joint-relatedpain1,2.
Minimally invasive treatments for the treatment of chronic cervical pain include microvascular decompression, medial branch blocks, and intraarticular steroid injections1,2. These approaches, although effective in some cases, have limited long-term efficacy.
Whenever there is a clear indication that the pain has its origin in the cervical facet joints, radiofrequency ablation (RFA) is a good treatment option for the management of several types of refractory cervical pain. RFA utilizes thermal energy to coagulate the sensory nerves, thus interrupting the nociceptive input arising from the cervical facet joint(s).
EFFECTIVENESS OF RFA
The clinical utility and long-term effectiveness of therapeutic RFA for the management of cervical facetogenic pain were thoroughly assessed in a systematic review by Manchikanti et al3. This study capitalized on the best evidence synthesis derived from one high-quality randomized clinical trial and several observational studies; thereby reporting the cumulative RFA outcomes of more than 300 treated patients. Beyond sustained and significant pain relief -achieved in more than 70% of the patients-, this study also linked cervical RF procedures with a functional status improvement and a reduced need for further medical procedures.
Complementary, two additional metanalyses have corroborated the effectiveness and safety of pulsed RF (PRF) for the management of neuropathic cervical pain conditions, such as trigeminal neuralgia and cervical radiculopathy4,5. Both studies provided high-quality and conclusive evidence that justify the therapeutic use of PRF for the management of these chronic refractory conditions.