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Cervical facet joint painRecommendationsDescriptionStrength of recommendationLevel of evidenceIntra-articular injections of corticosteroid should not be performed for the treatment of neck pain originating from the cervical facet joints Weak againstLowDescriptionStrength of recommendationLevel of evidenceTherapeutic (repetitive) cervical medial branch injections of local anesthetic with or without corticosteroid could be used for the treatment of neck pain originating for the cervical facet joints.WeakModerateDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment of the ramus medialis of the ramus dorsalis could be used for the treatment of cervical facet joint painWeakLowClinical questionWhat the place for interventional pain treatments in the management of cervical facet joint pain? Researched treatment optionsFor patients suffering cervical facet joint painThe following three interventional treatment options were assessed:Intra-articular injectionsTherapeutic injections (local anesthetic with or without corticosteroid) at the cervical ramus medialis of the cervical ramus dorsalis Radiofrequency treatment of the cervical ramus medialis of the cervical ramus dorsalis Any comparators including sham, no treatment or other active treatment techniques were eligible. Inclusion was not restricted based on outcome. MethodsFor the search strategy and the methodology, we refer to the introduction.Results of literature searchA number of reviews about interventional treatment for cervical facet joint pain are published between 2010 and 2015. Some were of poor quality, for example with very limited searching. ADDIN EN.CITE <EndNote><Cite><Author>Smuck</Author><Year>2012</Year><RecNum>12041</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>12041</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471961730">12041</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Smuck, M.</author><author>Crisostomo, R. A.</author><author>Trivedi, K.</author><author>Agrawal, D.</author></authors></contributors><auth-address>PM&R Section, Department of Orthopaedic Surgery, Stanford University Spine Center, Redwood City, CA 94063, USA. msmuck@stanford.edu</auth-address><titles><title>Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review</title><secondary-title>PM R</secondary-title></titles><periodical><full-title>PM R</full-title><abbr-1>PM & R : the journal of injury, function, and rehabilitation</abbr-1></periodical><pages>686-92</pages><volume>4</volume><number>9</number><keywords><keyword>Back Pain/etiology/*surgery</keyword><keyword>Denervation/*methods</keyword><keyword>Humans</keyword><keyword>Pain Measurement</keyword><keyword>*Radio Waves</keyword><keyword>Spinal Nerves/*surgery</keyword><keyword>Zygapophyseal Joint/*innervation</keyword></keywords><dates><year>2012</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1934-1563 (Electronic)
1934-1482 (Linking)</isbn><accession-num>22980421</accession-num><urls><related-urls><url> Others appeared to be earlier versions of later reviews The majority of the most up to date reliable evidence can be found in the review by Manchikanti.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5jaGlrYW50aTwvQXV0aG9yPjxZZWFyPjIwMTU8L1ll
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ADDIN EN.CITE.DATA 2 Overall Risk of Bias of this Review (ROBIS ASSESSMENT, Kleijnen Syst Rev.) is rated as low.Intra articular injections Literature reviewThere are 2 RCT’s. One trial showed no significant differences between local anesthetic and steroid injections in pain relief in a sample of 41 patients with a short-follow-up. ADDIN EN.CITE <EndNote><Cite><Author>Barnsley</Author><Year>1994</Year><RecNum>2256</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>2256</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">2256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Barnsley, L.</author><author>Lord, S. M.</author><author>Wallis, B. J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia.</auth-address><titles><title>Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>1047-50</pages><volume>330</volume><number>15</number><keywords><keyword>Adult</keyword><keyword>Anesthetics, Local</keyword><keyword>Betamethasone/*therapeutic use</keyword><keyword>Bupivacaine</keyword><keyword>Cervical Vertebrae/*injuries/*physiopathology</keyword><keyword>Chronic Disease</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Injections, Intra-Articular</keyword><keyword>Lidocaine</keyword><keyword>Male</keyword><keyword>Nerve Block</keyword><keyword>Pain/*drug therapy/etiology</keyword><keyword>Whiplash Injuries/complications/*physiopathology</keyword></keywords><dates><year>1994</year><pub-dates><date>Apr 14</date></pub-dates></dates><accession-num>8127332</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>3 One trial had numerous methodological problems and a high withdrawal rate although some positive results were noted.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXJrPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 4 was not included for further analysis due to the described weaknesses and confounding factors (including trigger point injections and Botox injections in some patients with greater than 20% withdrawal rate).The second RCT is a small trial comparing steroid with local anesthetic in both groups over half of the patients the pain relief lasted no longer than a week, and less than 20 % of the patients had any substantial pain relief for more than 1 month. ADDIN EN.CITE <EndNote><Cite><Author>Barnsley</Author><Year>1994</Year><RecNum>2256</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>2256</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">2256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Barnsley, L.</author><author>Lord, S. M.</author><author>Wallis, B. J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia.</auth-address><titles><title>Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>1047-50</pages><volume>330</volume><number>15</number><keywords><keyword>Adult</keyword><keyword>Anesthetics, Local</keyword><keyword>Betamethasone/*therapeutic use</keyword><keyword>Bupivacaine</keyword><keyword>Cervical Vertebrae/*injuries/*physiopathology</keyword><keyword>Chronic Disease</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Injections, Intra-Articular</keyword><keyword>Lidocaine</keyword><keyword>Male</keyword><keyword>Nerve Block</keyword><keyword>Pain/*drug therapy/etiology</keyword><keyword>Whiplash Injuries/complications/*physiopathology</keyword></keywords><dates><year>1994</year><pub-dates><date>Apr 14</date></pub-dates></dates><accession-num>8127332</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>3ConclusionQuality of the evidence DescriptionLowThere is evidence of low quality that intra-articular injections of corticosteroids provide no better pain relief than intra articular injections of local anesthetics in short follow-up (1-4 weeks) Manchikanti et al 2015; Barnsley et al. 1994ConsiderationsThe RCT demonstrates that intra-articular corticosteroid injections provide no better pain relief than intra-articular injection of local anesthetic, although patient selection was performed by double diagnostic blocks. The authors conclude that intra-articular cervical corticosteroid injections are not effective. Cervical procedures for chronic pain management are more often linked with claims. ADDIN EN.CITE <EndNote><Cite><Author>Rathmell</Author><Year>2011</Year><RecNum>11406</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>11406</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1430723468">11406</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rathmell, J. P.</author><author>Michna, E.</author><author>Fitzgibbon, D. R.</author><author>Stephens, L. S.</author><author>Posner, K. L.</author><author>Domino, K. B.</author></authors></contributors><auth-address>Harvard Medical School, Boston, Massachusetts, USA. jprathmell@</auth-address><titles><title>Injury and liability associated with cervical procedures for chronic pain</title><secondary-title>Anesthesiology</secondary-title></titles><periodical><full-title>Anesthesiology</full-title></periodical><pages>918-26</pages><volume>114</volume><number>4</number><keywords><keyword>Adult</keyword><keyword>Anesthesia/*adverse effects</keyword><keyword>Anesthesiology</keyword><keyword>Cervical Vertebrae/injuries</keyword><keyword>Chronic Disease</keyword><keyword>Databases, Factual</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Insurance Claim Review</keyword><keyword>Male</keyword><keyword>*Malpractice</keyword><keyword>Middle Aged</keyword><keyword>Neck Pain/*therapy</keyword><keyword>Needlestick Injuries/*etiology</keyword><keyword>Societies, Medical</keyword><keyword>Spinal Cord Injuries/*etiology</keyword><keyword>United States</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1528-1175 (Electronic)
0003-3022 (Linking)</isbn><accession-num>21386702</accession-num><urls><related-urls><url> The cervical procedures form 22 % of all closed claims between 2005 and 2008 in the American Society of Anesthesiologists database. 91% of these claims were related to blocks or injections and 3% were related to intra articular injections. Severe and lethal complications have been reported after intra-arterial injection of corticosteroid. RecommendationsDescriptionStrength of recommendationLevel of evidenceIntra-articular injections of corticosteroid should not be performed for the treatment of neck pain originating from the cervical facet joints Weak againstLowTherapeutic (repetitive) cervical medial branch injections (local anesthetic with or without corticosteroid) Literature review1 RCT and 1 observational study were found. The RCT found 85% of the local anesthetic group and 93% of the local anesthetic plus steroid group reported pain relief at the end of two years. ADDIN EN.CITE <EndNote><Cite><Author>Manchikanti</Author><Year>2010</Year><RecNum>12043</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>12043</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471962247">12043</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manchikanti, L.</author><author>Singh, V.</author><author>Falco, F. J.</author><author>Cash, K. A.</author><author>Fellows, B.</author></authors></contributors><auth-address>Pain Management Center of Paducah, Paducah, Kentucky, USA. drlm@</auth-address><titles><title>Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial</title><secondary-title>Pain Physician</secondary-title></titles><periodical><full-title>Pain Physician</full-title></periodical><pages>437-50</pages><volume>13</volume><number>5</number><keywords><keyword>Adrenal Cortex Hormones/*administration & dosage</keyword><keyword>Adult</keyword><keyword>Anesthetics, Local/*administration & dosage</keyword><keyword>Bupivacaine/administration & dosage</keyword><keyword>Cervical Vertebrae</keyword><keyword>Chronic Disease</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neck Pain/*drug therapy</keyword><keyword>Nerve Block/*methods</keyword><keyword>Pain Measurement</keyword><keyword>Treatment Outcome</keyword><keyword>Zygapophyseal Joint/drug effects</keyword></keywords><dates><year>2010</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>2150-1149 (Electronic)
1533-3159 (Linking)</isbn><accession-num>20859313</accession-num><urls><related-urls><url> The majority of patients had to receive 4 to 5 procedures in one year to accomplish this.The observational study found improvements compared to baseline in pain relief, disability status, psychological status and return to work. ADDIN EN.CITE <EndNote><Cite><Author>Manchikanti</Author><Year>2004</Year><RecNum>12044</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>12044</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1471963697">12044</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manchikanti, L.</author><author>Manchikanti, K. N.</author><author>Damron, K. S.</author><author>Pampati, V.</author></authors></contributors><auth-address>Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky 42003, USA. drm@</auth-address><titles><title>Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study</title><secondary-title>Pain Physician</secondary-title></titles><periodical><full-title>Pain Physician</full-title></periodical><pages>195-201</pages><volume>7</volume><number>2</number><dates><year>2004</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1533-3159 (Print)
1533-3159 (Linking)</isbn><accession-num>16868592</accession-num><urls><related-urls><url> ConclusionQuality of the evidence DescriptionModerateThere is evidence of moderate quality that therapeutic injections of the cervical ramus medialis of the ramus dorsalis with local anesthetic with or without corticosteroid reduce pain, and improve disability, psychological status and return to work for up to 2 years.Manchikanti et al. 2004 and 2010ConsiderationsProcedures requiring a needle placement at the ramus medialis involve the risk of puncturing the arteria vertebralis if the needle is pushed too far anteriorly into the foramen intervertebrale. Verification of the needle position should be made under antero-posterior fluoroscopy to prevent intrathecal injection or injection of the local anesthetic into the spinal cord. In an observational study, the incidence of inadvertent intravascular penetration for medial branch blocks at spinal level was reported to be 3.9%, comparable with the incidence at lumbar level (3.7%). Some patients experienced short-term vasovagal reactions. The intravascular uptake of local anesthetic and contrast solution (due to direct injection into a vessel) was thought to be responsible for false negative diagnostic blocks. No systemic effects were reported. ADDIN EN.CITE <EndNote><Cite><Author>Verrills</Author><Year>2008</Year><RecNum>4571</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>4571</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">4571</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Verrills, P.</author><author>Mitchell, B.</author><author>Vivian, D.</author><author>Nowesenitz, G.</author><author>Lovell, B.</author><author>Sinclair, C.</author></authors></contributors><auth-address>Metro Spinal Clinic, Caulfield South, Melbourne, Australia.</auth-address><titles><title>The incidence of intravascular penetration in medial branch blocks: cervical, thoracic, and lumbar spines</title><secondary-title>Spine (Phila Pa 1976)</secondary-title></titles><periodical><full-title>Spine (Phila Pa 1976)</full-title></periodical><pages>E174-7</pages><volume>33</volume><number>6</number><edition>2008/03/18</edition><keywords><keyword>Anesthesia, Spinal/*adverse effects</keyword><keyword>Cervical Vertebrae/*blood supply/drug effects</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Injections, Intra-Arterial</keyword><keyword>Injections, Intravenous</keyword><keyword>Lumbar Vertebrae/*blood supply/drug effects</keyword><keyword>*Medical Errors/trends</keyword><keyword>Nerve Block/adverse effects</keyword><keyword>Thoracic Vertebrae/*blood supply/drug effects</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar 15</date></pub-dates></dates><isbn>1528-1159 (Electronic)
1528-1159 (Linking)</isbn><accession-num>18344846</accession-num><urls><related-urls><url> [pii]</electronic-resource-num><language>eng</language></record></Cite></EndNote>8 A report on transient tetraplegia after cervical facet joint injection, done without imaging, illustrates the vulnerability of the cervical arteries. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZWNrbWFubjwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+
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ADDIN EN.CITE.DATA 9 Appropriate monitoring of the vital signs and availability of resuscitation equipment are essential.Infections have been described, but the incidence is unknown and probably very low. ADDIN EN.CITE <EndNote><Cite><Author>Rathmell</Author><Year>2006</Year><RecNum>1573</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>1573</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1573</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rathmell, J. P.</author><author>Lake, T.</author><author>Ramundo, M. B.</author></authors></contributors><auth-address>University of Vermont College of Medicine, Burlington, VT 05403, USA. james.rathmell@uvm.edu</auth-address><titles><title>Infectious risks of chronic pain treatments: injection therapy, surgical implants, and intradiscal techniques</title><secondary-title>Reg Anesth Pain Med</secondary-title><short-title>complications</short-title></titles><periodical><full-title>Reg Anesth Pain Med</full-title></periodical><pages>346-52</pages><volume>31</volume><number>4</number><keywords><keyword>Analgesia, Epidural/adverse effects</keyword><keyword>*Bacterial Infections</keyword><keyword>Chronic Disease</keyword><keyword>Electrocoagulation/adverse effects</keyword><keyword>Humans</keyword><keyword>Infusion Pumps, Implantable</keyword><keyword>Injections, Spinal/adverse effects</keyword><keyword>Intervertebral Disk/*surgery</keyword><keyword>Low Back Pain/drug therapy/surgery</keyword><keyword>Pain/*drug therapy/*surgery</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2006</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><accession-num>16857554</accession-num><work-type>recomm read</work-type><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>10 ?A recent report on septic arthritis of the facet joints included two cases of cervical facet joints. In these cases, the port of entry could not be identified, but in one lumbar case report, percutaneous injection was directly linked to this severe complication. ADDIN EN.CITE <EndNote><Cite><Author>Michel-Batot</Author><Year>2008</Year><RecNum>3338</RecNum><DisplayText><style face="superscript">11</style></DisplayText><record><rec-number>3338</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">3338</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Michel-Batot, C.</author><author>Dintinger, H.</author><author>Blum, A.</author><author>Olivier, P.</author><author>Laborde, F.</author><author>Bettembourg-Brault, I.</author><author>Pourel, J.</author><author>Loeuille, D.</author><author>Chary-Valckenaere, I.</author></authors></contributors><auth-address>Rheumatology Department, Brabois Teaching Hospital, CHU Brabois, 54000 Nancy, France. christine.batot@chu-nancy.fr</auth-address><titles><title>A particular form of septic arthritis: septic arthritis of facet joint</title><secondary-title>Joint Bone Spine</secondary-title></titles><periodical><full-title>Joint Bone Spine</full-title><abbr-1>Joint, bone, spine : revue du rhumatisme</abbr-1></periodical><pages>78-83</pages><volume>75</volume><number>1</number><keywords><keyword>*Arthritis, Infectious/complications/diagnosis/epidemiology/radionuclide</keyword><keyword>imaging</keyword><keyword>Cervical Vertebrae/microbiology</keyword><keyword>Comorbidity</keyword><keyword>Endocarditis, Bacterial/epidemiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Risk Factors</keyword><keyword>*Zygapophyseal Joint/microbiology/radionuclide imaging</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><accession-num>18093863</accession-num><urls><related-urls><url> Other potential complications of facet joint interventions are related to needle placement and drug administration; they include dural puncture, spinal cord trauma, spinal anesthesia, chemical meningitis, neural trauma, pneumothorax, radiation exposure, facet capsule rupture, hematoma formation, and side effects of corticosteroids. ADDIN EN.CITE <EndNote><Cite><Author>Boswell</Author><Year>2007</Year><RecNum>3342</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>3342</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">3342</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Boswell, M. V.</author><author>Colson, J. D.</author><author>Sehgal, N.</author><author>Dunbar, E. E.</author><author>Epter, R.</author></authors></contributors><auth-address>Texas Tech University Health Science Center, Lubbock, TX, USA. boswellmv@</auth-address><titles><title>A systematic review of therapeutic facet joint interventions in chronic spinal pain</title><secondary-title>Pain Physician</secondary-title></titles><periodical><full-title>Pain Physician</full-title></periodical><pages>229-53</pages><volume>10</volume><number>1</number><keywords><keyword>*Axotomy</keyword><keyword>Back Pain/*therapy</keyword><keyword>Catheter Ablation</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Humans</keyword><keyword>Injections, Intra-Articular</keyword><keyword>Injections, Spinal</keyword><keyword>*Nerve Block</keyword><keyword>Zygapophyseal Joint/*drug effects/*radiation effects</keyword></keywords><dates><year>2007</year><pub-dates><date>Jan</date></pub-dates></dates><accession-num>17256032</accession-num><urls><related-urls><url> The repetitive character of these injections and the possible complications justify downgrading the strength of recommendationRecommendationsDescriptionStrength of recommendationLevel of evidenceTherapeutic (repetitive) cervical medial branch injections of local anesthetic with or without corticosteroid could be used for the treatment of neck pain originating for the cervical facet joints.WeakModerateRF treatment of the cervical medial branch of the ramus dorsalis: Literature review1 RCT, 3 observational studies were identified.The RCT was small (24 patients) and statistical analysis had some limitations ADDIN EN.CITE <EndNote><Cite><Author>Lord</Author><Year>1996</Year><RecNum>1477</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>1477</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1477</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lord, S. M.</author><author>Barnsley, L.</author><author>Wallis, B. J.</author><author>McDonald, G. J.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia.</auth-address><titles><title>Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>1721-6</pages><volume>335</volume><number>23</number><keywords><keyword>Adult</keyword><keyword>Anesthetics, Local/diagnostic use</keyword><keyword>Cervical Vertebrae/*innervation</keyword><keyword>Chronic Disease</keyword><keyword>Denervation/*methods</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neck Pain/diagnosis/etiology/*surgery</keyword><keyword>Nerve Block</keyword><keyword>Radio Waves</keyword><keyword>Research Support, Non-U.S. Gov't</keyword><keyword>Treatment Outcome</keyword><keyword>Whiplash Injuries/*complications</keyword></keywords><dates><year>1996</year><pub-dates><date>Dec 5</date></pub-dates></dates><accession-num>8929263</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>13. However it showed that the median time of return of pain in the treatment group was 263 days and eight days in the control group. The patient population studied in this trial are patients who suffer chronic neck pain after an acceleration-deceleration accident, the whiplash associated disorder (WAD). One observational study ADDIN EN.CITE <EndNote><Cite><Author>Sapir</Author><Year>2001</Year><RecNum>1479</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>1479</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1479</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sapir, D. A.</author><author>Gorup, J. M.</author></authors></contributors><auth-address>Indiana Pain Institute, Lafayette, Indiana 47905, USA. sapirmd@</auth-address><titles><title>Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study</title><secondary-title>Spine</secondary-title></titles><periodical><full-title>Spine</full-title></periodical><pages>E268-73</pages><volume>26</volume><number>12</number><keywords><keyword>Accidents, Traffic/*legislation & jurisprudence</keyword><keyword>Adult</keyword><keyword>Cervical Vertebrae/innervation/*surgery</keyword><keyword>Comparative Study</keyword><keyword>*Electrosurgery</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Insurance, Accident/economics</keyword><keyword>Male</keyword><keyword>Neck Pain/economics/etiology/physiopathology/*surgery</keyword><keyword>Pain Measurement</keyword><keyword>Single-Blind Method</keyword><keyword>Treatment Outcome</keyword><keyword>Whiplash Injuries/complications/economics/*surgery</keyword><keyword>Zygapophyseal Joint/injuries/physiopathology/*surgery</keyword></keywords><dates><year>2001</year><pub-dates><date>Jun 15</date></pub-dates></dates><accession-num>11426167</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>14 also assessed RF of the ramus medialis of the ramus dorsalis in WAD patients. 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ADDIN EN.CITE.DATA 15 and 130 patients ADDIN EN.CITE <EndNote><Cite><Author>Speldewinde</Author><Year>2011</Year><RecNum>11706</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>11706</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1450724391">11706</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Speldewinde, G. C.</author></authors></contributors><auth-address>Capital Rehabilitation and Pain Management Centre, Canberra, ACT, Australia. gspeld@.au</auth-address><titles><title>Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>Pain Med</full-title></periodical><pages>209-18</pages><volume>12</volume><number>2</number><keywords><keyword>Australia</keyword><keyword>Humans</keyword><keyword>Nerve Block/*methods</keyword><keyword>Neurosurgical Procedures/*methods</keyword><keyword>Pain/psychology/*surgery</keyword><keyword>Pain Measurement</keyword><keyword>Prospective Studies</keyword><keyword>Radio Waves</keyword><keyword>Sacroiliac Joint/*surgery</keyword><keyword>Surveys and Questionnaires</keyword><keyword>*Treatment Outcome</keyword><keyword>Zygapophyseal Joint/*surgery</keyword></keywords><dates><year>2011</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1526-4637 (Electronic)
1526-2375 (Linking)</isbn><accession-num>21143762</accession-num><urls><related-urls><url> showed significant pain relief.In the first study 74% and 61% of the patients attending two different practices had complete pain relief or at least 80% pain relief for at least 6 months. In this study, the duration of the effect was 17-20 months for the first RF treatment and 15 months for the repeat treatment. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWNWaWNhcjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA 15 The second study showed success (average pain relief of 88%) in 76% of the patients that lasted for 12 months. Because the RCT is a small study and is performed in WAD patients the quality of the evidence is downgraded to lowConclusion Quality of the evidence DescriptionLowThere is evidence of low quality that radiofrequency treatment of the ramus medialis of the ramus dorsalis reduces pain in patients with cervical facet pain for 9 monthsLord et al. 1996; Sapir et al. 2001; MacVicar et al. 2012; Speldewinde et al.2011ConsiderationsThe most recent review from Manchikanti,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW5jaGlrYW50aTwvQXV0aG9yPjxZZWFyPjIwMTU8L1ll
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ADDIN EN.CITE.DATA 17, 18 Beside the only RCT of radiofrequency treatment for cervical facet joint pain in Whiplash Associated disorders, we found 5 additional observational studies pointing to a positive effect of radiofrequency treatment in non-post traumatic cervical facet joint pain. McDonald et al. ADDIN EN.CITE <EndNote><Cite><Author>McDonald</Author><Year>1999</Year><RecNum>1478</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>1478</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1478</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McDonald, G. J.</author><author>Lord, S. M.</author><author>Bogduk, N.</author></authors></contributors><auth-address>Newcastle Bone and Joint Institute, University of Newcastle, NSW, Australia.</auth-address><titles><title>Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain</title><secondary-title>Neurosurgery</secondary-title></titles><periodical><full-title>Neurosurgery</full-title></periodical><pages>61-7; discussion 67-8</pages><volume>45</volume><number>1</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Anesthetics, Local/diagnostic use</keyword><keyword>Chronic Disease</keyword><keyword>Double-Blind Method</keyword><keyword>Electrocoagulation/*instrumentation</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Microsurgery/*instrumentation</keyword><keyword>Middle Aged</keyword><keyword>Neck Pain/diagnosis/*surgery</keyword><keyword>Nerve Block</keyword><keyword>Pain Measurement</keyword><keyword>Reoperation</keyword><keyword>Research Support, Non-U.S. Gov't</keyword><keyword>Spinal Nerve Roots/*surgery</keyword><keyword>Whiplash Injuries/surgery</keyword></keywords><dates><year>1999</year><pub-dates><date>Jul</date></pub-dates></dates><accession-num>10414567</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>19 reported complete pain relief in 71% of patients after an initial RF procedure of cervical the ramus medialis of the ramus dorsalis. No patient who failed to respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure, relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures are included but 422 days when only successful cases are considered. A prospective study included all patients whose diagnosis cervical facet joint pain was confirmed by controlled cervical medial branch blocks. The duration of pain relief for all consecutive procedures were determined during a two-year period. Eighty percent of the assessable procedures resulted in significant pain relief during a mean of 36 weeks. ADDIN EN.CITE <EndNote><Cite><Author>Barnsley</Author><Year>2005</Year><RecNum>1670</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>1670</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1670</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Barnsley, L.</author></authors></contributors><auth-address>Department of Rheumatology, Concord Hospital, Sydney, Australia. les.barnsley@email.cs..au</auth-address><titles><title>Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients</title><secondary-title>Pain Med</secondary-title></titles><periodical><full-title>Pain Med</full-title></periodical><pages>282-6</pages><volume>6</volume><number>4</number><keywords><keyword>Cervical Vertebrae/innervation/*surgery</keyword><keyword>*Electrosurgery</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Neck Pain/*surgery</keyword><keyword>Pain Measurement</keyword><keyword>Treatment Outcome</keyword><keyword>Zygapophyseal Joint/pathology/surgery</keyword></keywords><dates><year>2005</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><accession-num>16083457</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>20 A clinical outcome study on the effect of CT-guided RF treatment of the cervical facet joints showed that after 90 days 56,5% of the patients had experienced a definite pain reduction of >75% (VAS). 28,3% patients obtained alleviation of <50% (VAS), within the first three postoperative months. ADDIN EN.CITE <EndNote><Cite><Author>Gevargez</Author><Year>2001</Year><RecNum>12113</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>12113</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1476089994">12113</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gevargez, A.</author><author>Braun, M.</author><author>Schirp, S.</author><author>Weinsheimer, P. A.</author><author>Groenemeyer, D. H.</author></authors></contributors><auth-address>Institut fur Mikrotherapie und Radiologie Universitat Witten/Herdecke, Bochum. gevargez@microtherapy.de</auth-address><titles><title>[Chronic non radicular cervicocephalic syndrome: CT-guided percutaneous RF-thermocoagulation of the zygapophysial joints]</title><secondary-title>Schmerz</secondary-title></titles><periodical><full-title>Schmerz</full-title></periodical><pages>186-91</pages><volume>15</volume><number>3</number><keywords><keyword>Electrocoagulation/*methods</keyword><keyword>Humans</keyword><keyword>Pain/etiology</keyword><keyword>*Pain Management</keyword><keyword>Pain Measurement</keyword><keyword>Pain, Postoperative/*therapy</keyword><keyword>*Tomography, X-Ray Computed</keyword><keyword>Zygapophyseal Joint/innervation/*physiopathology/*surgery</keyword></keywords><dates><year>2001</year><pub-dates><date>Jun</date></pub-dates></dates><orig-pub>Chronisches, nichtradikulares HWS-Syndrom. CT-gesteuerte perkutane Radiofrequenz-Thermokoagulation der zervikalen Zygapophysialgelenke--eine Pilotstudie.</orig-pub><isbn>0932-433X (Print)
0932-433X (Linking)</isbn><accession-num>11810354</accession-num><urls><related-urls><url> exploratory study evaluated the therapeutic effect and its duration of RF treatment, using the single posterior-lateral approach in patients suffering from facet joint degeneration. Overall pain relief was reported in 55.4% at 2-month follow-up. At 3-year follow-up, 30% of the patients still reported pain reduction. ADDIN EN.CITE <EndNote><Cite><Author>van Eerd</Author><Year>2014</Year><RecNum>10427</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>10427</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="1390310957">10427</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author> van Eerd, M.</author><author>de Meij, N.</author><author>Dortangs, E.</author><author>Kessels, A.</author><author>van Zundert, J.</author><author>Lataster, A.</author><author>Patijn, J.</author><author>van Kleef, M.</author></authors></contributors><auth-address>Department of Anaesthesiology and Pain management, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Anaesthesiology, Pain Management and Intensive Care, Amphia Hospital, Breda, The Netherlands.</auth-address><titles><title>Long-term Follow-up of Cervical Facet Medial Branch Radiofrequency Treatment With the Single Posterior-lateral Approach: An Exploratory Study</title><secondary-title>Pain Pract</secondary-title><short-title>chronic neck pain</short-title></titles><periodical><full-title>Pain Pract</full-title></periodical><pages>8-15</pages><volume>14</volume><number>1</number><dates><year>2014</year><pub-dates><date>Jan</date></pub-dates></dates><orig-pub>retrospecitve audit</orig-pub><accession-num>23496651</accession-num><label>RF 2014</label><work-type>RF</work-type><urls><related-urls><url> study on 92 patients who underwent RF denervation of the cervical facet joints analyzed the factors influencing the treatment outcome. ADDIN EN.CITE <EndNote><Cite><Author>Cohen</Author><Year>2007</Year><RecNum>1852</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>1852</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1852</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cohen, S. P.</author><author>Bajwa, Z. H.</author><author>Kraemer, J. J.</author><author>Dragovich, A.</author><author>Williams, K. A.</author><author>Stream, J.</author><author>Sireci, A.</author><author>McKnight, G.</author><author>Hurley, R. W.</author></authors></contributors><auth-address>Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD; Department of Surgery, Walter Reed Army Medical Center, Washington, DC.</auth-address><titles><title>Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis</title><secondary-title>Reg Anesth Pain Med</secondary-title></titles><periodical><full-title>Reg Anesth Pain Med</full-title></periodical><pages>495-503</pages><volume>32</volume><number>6</number><dates><year>2007</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><accession-num>18035295</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>23 The only clinical variable associated with success was paraspinal tenderness. Factors associated with treatment failure included radiation to the head, opioid use, and pain exacerbated by neck extension and/or rotation. ?After RF treatment, postoperative burning pain is regularly reported. This pain disappears after 1 to 3 weeks. ADDIN EN.CITE <EndNote><Cite><Author>Haspeslagh</Author><Year>2006</Year><RecNum>1499</RecNum><DisplayText><style face="superscript">24</style></DisplayText><record><rec-number>1499</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">1499</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haspeslagh, S. R.</author><author>Van Suijlekom, H. A.</author><author>Lame, I. E.</author><author>Kessels, A. G.</author><author>van Kleef, M.</author><author>Weber, W. E.</author></authors></contributors><auth-address>Depts, Anesthesiology, Clinical Epidemiology, and Neurology, University Hospital Maastricht, The Netherlands. wweb@neurologie.azm.nl.</auth-address><titles><title>Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684]</title><secondary-title>BMC Anesthesiol</secondary-title></titles><periodical><full-title>BMC Anesthesiol</full-title></periodical><pages>1</pages><volume>16</volume><number>6</number><dates><year>2006</year></dates><accession-num>16483374</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>24? Smith et al. ADDIN EN.CITE <EndNote><Cite><Author>Smith</Author><Year>2005</Year><RecNum>3346</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>3346</rec-number><foreign-keys><key app="EN" db-id="ver2pweeyf0df2ervxhv0xs1v2z9x2zx52sr" timestamp="0">3346</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Smith, M.</author><author>Ferretti, G.</author><author>Mortazavi, S.</author></authors></contributors><auth-address>Pain Management Center, St. Luke's Hospital, 801 Ostrum Street, Bethlehem, PA 18015, USA.</auth-address><titles><title>Radiographic changes induced after cervical facet radiofrequency denervation</title><secondary-title>Spine J</secondary-title></titles><periodical><full-title>Spine J</full-title></periodical><pages>668-71</pages><volume>5</volume><number>6</number><keywords><keyword>Adult</keyword><keyword>Catheter Ablation/*methods</keyword><keyword>Cervical Vertebrae/*pathology/*surgery</keyword><keyword>Denervation/*adverse effects</keyword><keyword>False Positive Reactions</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging</keyword><keyword>Myositis/*etiology/*pathology</keyword><keyword>Neck Pain/*surgery</keyword></keywords><dates><year>2005</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><accession-num>16291110</accession-num><urls><related-urls><url> found contrast enhancement on MRI typical for paraspinal abscess, even without apparent infection, which was attributed to a noninfectious post-inflammatory process. There are no incidence data on side effects and complications following cervical RF facet denervation. RecommendationsDescriptionStrength of recommendationLevel of evidenceRadiofrequency treatment of the ramus medialis of the ramus dorsalis could be used for the treatment of cervical facet joint painWeakLowReferences ADDIN EN.REFLIST 1Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM & R : the journal of injury, function, and rehabilitation. 2012;4:686-692.2Manchikanti L, Kaye AD, Boswell MV, et al. A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain. Pain Physician. 2015;18:E535-582.3Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med. 1994;330:1047-1050.4Park SC, Kim KH. Effect of adding cervical facet joint injections in a multimodal treatment program for long-standing cervical myofascial pain syndrome with referral pain patterns of cervical facet joint syndrome. Journal of anesthesia. 2012;26:738-745.5Rathmell JP, Michna E, Fitzgibbon DR, Stephens LS, Posner KL, Domino KB. Injury and liability associated with cervical procedures for chronic pain. Anesthesiology. 2011;114:918-926.6Manchikanti L, Singh V, Falco FJ, Cash KA, Fellows B. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician. 2010;13:437-450.7Manchikanti L, Manchikanti KN, Damron KS, Pampati V. Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study. Pain Physician. 2004;7:195-201.8Verrills P, Mitchell B, Vivian D, Nowesenitz G, Lovell B, Sinclair C. The incidence of intravascular penetration in medial branch blocks: cervical, thoracic, and lumbar spines. Spine (Phila Pa 1976). 2008;33:E174-177.9Heckmann JG, Maihofner C, Lanz S, Rauch C, Neundorfer B. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance. Clinical neurology and neurosurgery. 2006;108:709-711.10Rathmell JP, Lake T, Ramundo MB. Infectious risks of chronic pain treatments: injection therapy, surgical implants, and intradiscal techniques. Reg Anesth Pain Med. 2006;31:346-352.11Michel-Batot C, Dintinger H, Blum A, et al. A particular form of septic arthritis: septic arthritis of facet joint. Joint, bone, spine : revue du rhumatisme. 2008;75:78-83.12Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229-253.13Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335:1721-1726.14Sapir DA, Gorup JM. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study. Spine. 2001;26:E268-273.15MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012;13:647-654.16Speldewinde GC. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med. 2011;12:209-218.17Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009;32:S117-140.18Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221.19McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery. 1999;45:61-67; discussion 67-68.20Barnsley L. Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients. Pain Med. 2005;6:282-286.21Gevargez A, Braun M, Schirp S, Weinsheimer PA, Groenemeyer DH. [Chronic non radicular cervicocephalic syndrome: CT-guided percutaneous RF-thermocoagulation of the zygapophysial joints]. Schmerz. 2001;15:186-191.22van Eerd M, de Meij N, Dortangs E, et al. Long-term Follow-up of Cervical Facet Medial Branch Radiofrequency Treatment With the Single Posterior-lateral Approach: An Exploratory Study. Pain Pract. 2014;14:8-15.23Cohen SP, Bajwa ZH, Kraemer JJ, et al. Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis. Reg Anesth Pain Med. 2007;32:495-503.24Haspeslagh SR, Van Suijlekom HA, Lame IE, Kessels AG, van Kleef M, Weber WE. Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684]. BMC Anesthesiol. 2006;16:1.25Smith M, Ferretti G, Mortazavi S. Radiographic changes induced after cervical facet radiofrequency denervation. Spine J. 2005;5:668-671. ................
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