Cervical facet syndrome

Cervical facet syndrome is a combination of symptoms, including pain in the neck, head, shoulder and in the proximal part of the upper limb, irradiating in a non-dermatomic type. Pain is weak, blunt. It may be unilateral, bilateral, it is believed that the pain is a consequence of the pathology of the facet joint.

Pain in the cervical facet syndrome increases with (flexion, extension and lateral flexion in the cervical spine, often intensified in the morning after physical exertion.) Each facet joint receives innervation from two levels: fibers of the dorsal branches of the corresponding and higher segment.

[1], [2]

Symptoms of the cervical facet syndrome

Many patients with faceted syndrome have deep pain (palpation of paravertebral muscles, muscle spasm may occur, patients show reduced volume of movements in the cervical spine, often complain of pain during flexion, extension, and lateral flexion in the cervical region. Concomitant radiculopathy, plexopathy or tunnel neuropathy of any motor or sensory deficiency is not detected.

When the facet joint is affected at the C1-2 level, the pain extends to the posterior auricular and occipital areas. With C2-3 damage, the pain can spread to the forehead and eye area.

The pain originating from the facet joints C3-4 extends upwards to the suboccipital region and down to the posterolateral region of the neck, the pain from the C4-5 facet joints irradiates to the base of the neck. The pain from the C5-6 facet joints extends to the shoulders and the interlateral area, and from C6-7 to the supraspinatus and subacute fossa.

[3]

Clinical characteristics of cervical facet syndrome

Cervical facet syndrome is a common cause of pain in the neck, occiput, shoulder and upper limb. Often it is mistaken for cervicalgia and cervical myositis. Diagnostic intra-articular facet blockade can confirm the diagnosis. Clinicians should rule out cervical spine diseases, such as syringomyelia, which at the initial stage look similar. Ankylosing spondylitis can also manifest as a cervical facet syndrome, it is necessary to identify it correctly to prevent joint damage and functional incapacity. Many pain specialists believe that cervical facet and atlanto-occipital blockades are not adequately applied in treatment after whiplash cervicalgia and cervicogenic headache and should be considered when cervical epidural block and occipital nerve blockade failed to provide temporary relief of the syndrome headache and neck pain.

[4], [5], [6], [7]

Diagnostics of the cervical facet syndrome

By the age of fifty, virtually all patients with radiography have any changes in the facet joints of the cervical spine. Pain specialists have long discussed the clinical significance of such findings until such time as computer and magnetic resonance imaging appeared, and the connections between altered facet joints and cervical nerve roots and other adjacent structures were not elucidated. MRI of the cervical spine should be performed for all patients suspected of having cervical facet syndrome. The data obtained with this expensive imaging technique can provide only a presumptive diagnosis. To confirm that this particular facet joint causes pain, a diagnostic intraarticular injection of a local anesthetic into this joint is required. If the diagnosis of "cervical facet syndrome" is uncertain, laboratory tests should be conducted, including a general blood test, ESR, antinuclear antibodies, HLA B-27, antigen testing and biochemical analysis, to exclude other causes of pain.

[8], [9]

Differential diagnosis

Cervical facet syndrome is the diagnosis of exclusion, which is confirmed by a combination of history, physical examination, radiography, MRI and intraarticular injection into the interested facet joint. Pain syndromes capable of mimicking the cervical facet syndrome include cervical bursitis, cervical myogenic pain syndrome, inflammatory arthritis, blockages of the cervical spine, diseases of the roots, plexus and nerves.

Treatment of the cervical facet syndrome

In the treatment of cervical facet syndrome, a multi-level approach is most effective. Thermal procedures and relaxing massage in combination with NSAIDs (eg, diclofenac, lornoxicam) and muscle relaxants (eg, tizanidine) are justified starting treatment. The next logical step is to use blockades of cervical facet joints conducted only under the control of fluoroscopy. For symptomatic relief, blockages of the medial branch of the dorsal nerve or intraarticular injections into the facet joint of local anesthetics or steroids are extremely effective. The underlying depression disorder is best treated with tricyclic antidepressants.

Often cervical facet blockade is combined with atlanto-occipital blockade in the treatment of pain in this area. Although from the anatomical position the atlanto-occipital joint is not truly faceted, the technique used by pain specialists is analogous to that of the facet blockade.

Complications and Diagnostic Errors

Due to the proximity of the spinal cord and the exit of the nerve roots, the cervical facet blockade should be performed by a specialist familiar with regional anatomy and surgical treatment of pain. Due to the proximity of the vertebral artery and the vascular structures of this region, the likelihood of intravascular injection is high, and getting even a small amount of local anesthetic into the vertebral artery can cause paroxysm. Given the close location of the brain and brainstem, ataxia is frequent due to intravascular injection of a local anesthetic with cervical facet blockade. Many patients also complain of transient strengthening of headache and cervicalgia after injection into the joint.

[10], [11], [12], [13], [14]