Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Robert W Hurley, Meredith C B Adams, Meredith Barad, Arun Bhaskar, Anuj Bhatia, Andrea Chadwick, Timothy R Deer, Jennifer Hah, W Michael Hooten, Narayan R Kissoon, David Wonhee Lee, Zachary Mccormick, Jee Youn Moon, Samer Narouze, David A Provenzano, Byron J Schneider, Maarten van Eerd, Jan Van Zundert, Mark S Wallace, Sara M Wilson, Zirong Zhao, Steven P Cohen, Robert W Hurley, Meredith C B Adams, Meredith Barad, Arun Bhaskar, Anuj Bhatia, Andrea Chadwick, Timothy R Deer, Jennifer Hah, W Michael Hooten, Narayan R Kissoon, David Wonhee Lee, Zachary Mccormick, Jee Youn Moon, Samer Narouze, David A Provenzano, Byron J Schneider, Maarten van Eerd, Jan Van Zundert, Mark S Wallace, Sara M Wilson, Zirong Zhao, Steven P Cohen

Abstract

Background: The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.

Methods: In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4-5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.

Results: Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.

Conclusions: Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

Keywords: analgesia; anesthesia; anticoagulants; injections; local; neck pain; spinal.

Conflict of interest statement

Competing interests: SPC has served as a consultant for Avanos, SPR, Releviate, Persica and Scilex in the past 3 years. ZLM receives research funding from Avanos. Anuj Bhatia receives research funding from Medtronic and consults for Bioventus. DAP has consulted for Avanos, Boston Scientific, Heron, Medtronic, Wise and Nevro. He has received research support from Avanos, Medtronic, Nevro, Stimgenics, and Abbott. DWL has served as a member of the Abbott speaker’s bureau. WMH receives funding from US WorldMeds. BJS is a consultant for State Farm and AIM Specialty Health. NK served on an advisory board for Bright Minds Biosciences, received research funding from Nevro Corporation, and received royalties from UpToDate. TD is a consultant for Abbott, Vertos, Axonics, Flowonix, SpineThera, Saluda Medical, Nalu, Medtronic, Nevro, SI Bone, Stimgenics, SPR Therapeutics, Cornerloc, Boston Scientific, PainTeq, Ethos, and Vertiflex; is a member of the advisory board for Abbott, Vertos, Flowonix, Nalu, SPR Therapeutics and Vertiflex; has stock options in Bioness, Vertiflex, Axonic, Vertos, SpineThera, Nalu, Cornerloc, PainTeq and SPR Therapeutics, and has common stock in Saluda Medical. He is a research consultant for Abbott, Vertos, Mainstay Medical, Saluda Medical, SPR Therapeutics, Boston Scientific and Vertiflex, and has a patent pending for the dorsal root ganglion paddle lead with Abbott.

© American Society of Regional Anesthesia & Pain Medicine 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

Figures

Figure 1
Figure 1
Posterior (A) and lateral (B) segmental maps showing the typical pain referral patterns of the atlanto–occipital (C0–C1, blue) and atlanto–axial (C1–2, red) joints. Striped areas (blue/red hash marks) represent overlapping atlanto–occipital and atlanto–axial pain maps.
Figure 2
Figure 2
Posterior (A) and lateral (B) segmental maps showing pain referral patterns from the cervical facet joints (C2–3, red; C3–4, black; C4–5, green; C5–6, purple; C6–7, yellow; C7–T1, blue). Striped areas (hash marks) represent overlapping cervical facet joint pain maps.
Figure 3
Figure 3
Posterior (A) and sagittal (B) images demonstrating the relationship between the upper cervical joints, vertebral artery and nerve supply.
Figure 4
Figure 4
Axial view of the cervical spine demonstrating different cannula orientations.
Figure 5
Figure 5
Ultrasound image demonstrating an artery running across a cervical facet articular pillar. AP, articular pillar; at, anterior tubercle of the transverse process; pt, posterior tubercle of the transverse process.

References

    1. Safiri S, Kolahi A-A, Hoy D, et al. . Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the global burden of disease study 2017. BMJ 2020;368:m791. 10.1136/bmj.m791
    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006;15:834–48. 10.1007/s00586-004-0864-4
    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016;388:1545–602. 10.1016/S0140-6736(16)31678-6
    1. Hogg-Johnson S, van der Velde G, Carroll LJ, et al. . The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. Spine 2008;33:S39–51. 10.1097/BRS.0b013e31816454c8
    1. Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002;22:15–22. 10.1046/j.1468-2982.2002.00293.x
    1. Manchikanti L, Singh V, Rivera J, et al. . Prevalence of cervical facet joint pain in chronic neck pain. Pain Physician 2002;5:243–9.
    1. Aprill C, Bogduk N. The prevalence of cervical zygapophyseal joint pain. A first approximation. Spine 1992;17:744–7.
    1. Bogduk N, Marsland A. The cervical zygapophysial joints as a source of neck pain. Spine 1988;13:610–7.
    1. Speldewinde GC, Bashford GM, Davidson IR. Diagnostic cervical zygapophyseal joint blocks for chronic cervical pain. Med J Aust 2001;174:174–6. 10.5694/j.1326-5377.2001.tb143210.x
    1. Barnsley L, Lord SM, Wallis BJ, et al. . The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine 1995;20:20–5. 10.1097/00007632-199501000-00004
    1. Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain 1994;58:283–307. 10.1016/0304-3959(94)90123-6
    1. Lord SM, Barnsley L, Wallis BJ, et al. . Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine 1996;21:1737–44. 10.1097/00007632-199608010-00005
    1. Aprill C, Dwyer A, Bogduk N. Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine 1990;15:458–61. 10.1097/00007632-199006000-00005
    1. Manchikanti L, Manchikanti KN, Pampati V, et al. . The prevalence of facet-joint-related chronic neck pain in postsurgical and nonpostsurgical patients: a comparative evaluation. Pain Pract 2008;8:5–10. 10.1111/j.1533-2500.2007.00169.x
    1. Nevalainen MT, Foran PJ, Roedl JB, et al. . Cervical facet oedema: prevalence, correlation to symptoms, and follow-up imaging. Clin Radiol 2016;71:570–5. 10.1016/j.crad.2016.02.026
    1. Lee MJ, Riew KD. The prevalence cervical facet arthrosis: an osseous study in a cadveric population. Spine J 2009;9:711–4. 10.1016/j.spinee.2009.04.016
    1. van der Donk J, Schouten JS, Passchier J, et al. . The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. J Rheumatol 1991;18:1884–9.
    1. International Spine Intervention Society . Cervical medial branch thermal radiofrequency neurotomy. In: Bogduk N, ed. Practice guidelines for spinal diagnostic and treatment procedures. 2nd edn. San Francisco, 2013: 133–69.
    1. Burnham T, Conger A, Salazar F, et al. . The effectiveness of cervical medial branch radiofrequency ablation for chronic facet joint syndrome in patients selected by a practical medial branch block paradigm. Pain Med 2020;21:2071–6. 10.1093/pm/pnz358
    1. Cohen 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. 10.1016/j.rapm.2007.05.009
    1. Engel A, King W, Schneider BJ, et al. . The effectiveness of cervical medial branch thermal radiofrequency neurotomy stratified by selection criteria: a systematic review of the literature. Pain Med 2020;21:2726–37. 10.1093/pm/pnaa219
    1. Falco FJE, Datta S, Manchikanti L, et al. . An updated review of the diagnostic utility of cervical facet joint injections. Pain Physician 2012;15:E807–38.
    1. Holz SC, Sehgal N. What is the correlation between facet joint radiofrequency outcome and response to comparative medial branch blocks? Pain Physician 2016;19:163–72.
    1. Manchikanti L, Sanapati MR, Pampati V, et al. . Update of utilization patterns of facet joint interventions in managing spinal pain from 2000 to 2018 in the US fee-for-service Medicare population. Pain Physician 2020;23:E133–49.
    1. Manchikanti L, Pampati V, Soin A, et al. . Trends of expenditures and utilization of facet joint interventions in fee-for-service (FFS) Medicare population from 2009-2018. Pain Physician 2020;23:S129–47.
    1. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ 2017;358:j3221. 10.1136/bmj.j3221
    1. Manchikanti L, Kaye AD, Soin A, et al. . Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) guidelines facet joint interventions 2020 guidelines. Pain Physician 2020;23:S1–127.
    1. van Eerd M, de Meij N, Kessels A, et al. . Efficacy and long-term effect of radiofrequency denervation in patients with clinically diagnosed cervical facet joint pain: a double-blind randomized controlled trial. Spine 2021;46:285–93. 10.1097/BRS.0000000000003799
    1. Cohen SP, Bhaskar A, Bhatia A, et al. . Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020;45:424–67. 10.1136/rapm-2019-101243
    1. U.S. Preventive Services Task Force . Grade definitions. Available: [Accessed 29 Nov 2020].
    1. Cohen SP, Bhatia A, Buvanendran A, et al. . Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med 2018;43:521–46. 10.1097/AAP.0000000000000808
    1. Deer TR, Narouze S, Provenzano DA. The Neurostimulation Appropriateness Consensus Committee (NACC): recommendations on bleeding and coagulation management in neurostimulation devices. Neuromodulation 2017;20:51–62.
    1. Deer TR, Pope JE, Hayek SM, et al. . The Polyanalgesic Consensus Conference (PacC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation 2017;20:155–76. 10.1111/ner.12579
    1. Helm Ii S, Simopoulos TT, Stojanovic M, et al. . Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician 2017;20:447–70.
    1. Oxford Centre for Evidence-Based Medicine . Levels of evidence, March 2009. Available: [Accessed 1 Aug 2021].
    1. The GRADE Working Group . GRADE. Available: [Accessed 21 Feb 2021].
    1. Cohen SP, Wallace M, Rauck RL. Unique aspects of clinical trials of invasive therapies for chronic pain. Pain Rep 2019;4:e687. 10.1097/PR9.0000000000000687
    1. Narouze S. Cervicogenic headache. In: Benzon HT, Raja SN, Liu SS, eds. Essentials of pain medicine. 3rd edn. Philadelphia, PA: Elsevier Saunders, 2011: 278–82.
    1. Bogduk N, Corrigan B, Kelly P, et al. . Cervical headache. Med J Aust 1985;143:202–7. 10.5694/j.1326-5377.1985.tb122915.x
    1. Alix ME, Bates DK. A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther 1999;22:534–9. 10.1016/S0161-4754(99)70006-0
    1. Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol 1981;17:167–84.
    1. Yin W, Willard F, Dixon T, et al. . Ventral innervation of the lateral C1-C2 joint: an anatomical study. Pain Med 2008;9:1022–9. 10.1111/j.1526-4637.2008.00493.x
    1. Walker MT, Spitzer EM, Anatomy VM. Imaging, and common pain-generating degenerative pathologies of the spine. In: Benzon HT, Raja SN, Liu SS, eds. Essentials of pain medicine. 3rd edn. Philadelphia, PA: Elsevier Saunders, 2011: 53–79.
    1. Kobayashi T, Miyakoshi N, Konno N, et al. . Acute neck pain caused by arthritis of the lateral atlantoaxial joint. Spine J 2014;14:1909–13. 10.1016/j.spinee.2013.10.054
    1. Wasserman BR, Moskovich R, Razi AE. Rheumatoid arthritis of the cervical spine-clinical considerations. Bull NYU Hosp Jt Dis 2011;69:136–48.
    1. Klimo P, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am 2007;18:463–78. 10.1016/j.nec.2007.04.005
    1. Tulsi RS. Some specific anatomical features of the atlas and axis: dens, epitransverse process and articular facets. Aust N Z J Surg 1978;48:570–4. 10.1111/j.1445-2197.1978.tb00049.x
    1. Yang SY, Boniello AJ, Poorman CE, et al. . A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 2014;4:197–210. 10.1055/s-0034-1376371
    1. Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med 2007;8:344–53. 10.1111/j.1526-4637.2006.00201.x
    1. Dreyfuss P, Michaelsen M, Fletcher D. Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994;19:1125–31. 10.1097/00007632-199405001-00005
    1. Fukui S, Ohseto K, Shiotani M, et al. . Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain 1996;68:79–83. 10.1016/S0304-3959(96)03173-9
    1. Bogduk N. The neck and headaches. Neurol Clin 2004;22:151–71. 10.1016/S0733-8619(03)00100-2
    1. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep 2001;5:382–6. 10.1007/s11916-001-0029-7
    1. Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002;125:1496–509. 10.1093/brain/awf166
    1. Antonaci F, Fredriksen TA, Sjaastad O. Cervicogenic headache: clinical presentation, diagnostic criteria, and differential diagnosis. Curr Pain Headache Rep 2001;5:387–92. 10.1007/s11916-001-0030-1
    1. Ehni G, Benner B. Occipital neuralgia and C1-C2 arthrosis. N Engl J Med 1984;310:127. 10.1056/NEJM198401123100220
    1. Star MJ, Curd JG, Thorne RP. Atlantoaxial lateral mass osteoarthritis. A frequently overlooked cause of severe occipitocervical pain. Spine 1992;17:S71–6.
    1. Riesenburger RI, Klimo P, Yao KC. A fourth atlantoaxial joint: an initial description. Spine J 2011;11:e6–9. 10.1016/j.spinee.2011.02.016
    1. Salunke P, Futane S, Vaiphei K. Posterior bilateral supernumerary atlantoaxial facets: true or false joint? Spine 2013;38:E1633–5. 10.1097/BRS.0b013e3182a8a603
    1. Boucher AB, Kashlan ON, Gary MF, et al. . Atlantoaxial pseudoarticulation as a cause of neck pain: case illustration. J Neurosurg Spine 2018;30:182–3. 10.3171/2018.8.SPINE18918
    1. Eaton RG, Viljoen SV. Unilateral atlantoaxial pseudoarticulation: a case report, literature review, and proposed mechanism. Surg Neurol Int 2020;11:20. 10.25259/SNI_603_2019
    1. Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Med 2007;8:184–8. 10.1111/j.1526-4637.2006.00247.x
    1. Bogduk N. The neck and headaches. Neurol Clin 2014;32:471–87. 10.1016/j.ncl.2013.11.005
    1. Roche CJ, King SJ, Dangerfield PH, et al. . The atlanto-axial joint: physiological range of rotation on MRI and CT. Clin Radiol 2002;57:103–8. 10.1053/crad.2001.0703
    1. Elliott RE, Tanweer O, Smith ML, et al. . Outcomes of fusion for lateral atlantoaxial osteoarthritis: meta-analysis and review of literature. World Neurosurg 2013;80:e337–46. 10.1016/j.wneu.2012.08.018
    1. Park S, Woo J-E, Kim S, et al. . Torticollis caused by nontraumatic craniovertebral junction abnormalities. J Craniofac Surg 2018;29:1266–70. 10.1097/SCS.0000000000004441
    1. Vesela M, Stetkarova I, Lisy J. Prevalence of C1/C2 involvement in Czech rheumatoid arthritis patients, correlation of pain intensity, and distance of ventral subluxation. Rheumatol Int 2005;26:12–15. 10.1007/s00296-004-0506-5
    1. Lord SM, Barnsley L, Wallis BJ, et al. . Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:1721–6. 10.1056/NEJM199612053352302
    1. MacVicar J, Borowczyk JM, MacVicar AM, et al. . Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med 2012;13:647–54. 10.1111/j.1526-4637.2012.01351.x
    1. Chang U-K, Kim DH, Lee MC, et al. . Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 2007;7:33–9. 10.3171/SPI-07/07/033
    1. Bogduk N. On cervical zygapophysial joint pain after whiplash. Spine 2011;36:S194–9. 10.1097/BRS.0b013e3182387f1d
    1. Spitzer WO, Skovron ML, Salmi LR, et al. . Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 1995;20:1s–73.
    1. Smith AD, Jull G, Schneider G, et al. . A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash. BMC Musculoskelet Disord 2013;14:313. 10.1186/1471-2474-14-313
    1. IHS classification ICHD-3: cervicogenic headache. Available: [Accessed 7 Dec 2020].
    1. Lord SM, Barnsley L, Wallis BJ, et al. . Third occipital nerve headache: a prevalence study. J Neurol Neurosurg Psychiatry 1994;57:1187–90. 10.1136/jnnp.57.10.1187
    1. Barnsley L, Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth 1993;18:343–50.
    1. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine 1990;15:453–7. 10.1097/00007632-199006000-00004
    1. Cohen SP, Strassels SA, Kurihara C, et al. . Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology 2010;112:144–52. 10.1097/ALN.0b013e3181c38a82
    1. King W, Lau P, Lees R, et al. . The validity of manual examination in assessing patients with neck pain. Spine J 2007;7:22–6. 10.1016/j.spinee.2006.07.009
    1. Schneider GM, Jull G, Thomas K, et al. . Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain. Arch Phys Med Rehabil 2014;95:1695–701. 10.1016/j.apmr.2014.02.026
    1. Schneider GM, Jull G, Thomas K, et al. . Intrarater and interrater reliability of select clinical tests in patients referred for diagnostic facet joint blocks in the cervical spine. Arch Phys Med Rehabil 2013;94:1628–34. 10.1016/j.apmr.2013.02.015
    1. Heller CA, Stanley P, Lewis-Jones B, et al. . Value of X ray examinations of the cervical spine. BMJ 1983;287:1276–8. 10.1136/bmj.287.6401.1276
    1. Gore DR, Sepic SB, Gardner GM, et al. . Neck pain: a long-term follow-up of 205 patients. Spine 1987;12:1–5. 10.1097/00007632-198701000-00001
    1. Rudy IS, Poulos A, Owen L, et al. . The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: a cross-sectional study. Chiropr Man Therap 2015;23:9. 10.1186/s12998-015-0052-0
    1. Kim JH, Sharan A, Cho W, et al. . The prevalence of asymptomatic cervical and lumbar facet arthropathy: a computed tomography study. Asian Spine J 2019;13:417–22. 10.31616/asj.2018.0235
    1. Morishita K, Kasai Y, Uchida A. Hypertrophic change of facet joint in the cervical spine. Med Sci Monit 2008;14:CR62–4.
    1. Tiwari P, Kaur H, Kaur H, et al. . Prevalence of facet joint arthritis and its association with spinal pain in mountain population - a cross-sectional study. J Craniovertebr Junction Spine 2020;11:36–45. 10.4103/jcvjs.JCVJS_121_19
    1. Park MS, Lee YB, Moon S-H, et al. . Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients. Spine 2014;39:E713–8. 10.1097/BRS.0000000000000326
    1. Matar HE, Navalkissoor S, Berovic M, et al. . Is hybrid imaging (SPECT/CT) a useful adjunct in the management of suspected facet joints arthropathy? Int Orthop 2013;37:865–70. 10.1007/s00264-013-1811-y
    1. Lehman VT, Murphy RC, Kaufmann TJ, et al. . Frequency of discordance between facet joint activity on technetium Tc99m methylene diphosphonate SPECT/CT and selection for percutaneous treatment at a large multispecialty institution. AJNR Am J Neuroradiol 2014;35:609–14. 10.3174/ajnr.A3731
    1. Houseni M, Chamroonrat W, Zhuang H, et al. . Facet joint arthropathy demonstrated on FDG-PET. Clin Nucl Med 2006;31:418–9. 10.1097/01.rlu.0000223155.73661.f1
    1. Sawicki LM, Schaarschmidt BM, Heusch P, et al. . Value of 18 F-FDG PET/MRI for the outcome of CT-guided facet block therapy in cervical facet syndrome: initial results. J Med Imaging Radiat Oncol 2017;61:327–33. 10.1111/1754-9485.12565
    1. Rydman E, Kasina P, Ponzer S, et al. . Association between cervical degeneration and self-perceived nonrecovery after whiplash injury. Spine J 2019;19:1986–94. 10.1016/j.spinee.2019.07.017
    1. Daimon K, Fujiwara H, Nishiwaki Y, et al. . A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: follow-up of a cross-sectional study. J Orthop Sci 2019;24:579–83. 10.1016/j.jos.2018.11.011
    1. Uhrenholt L, Grunnet-Nilsson N, Hartvigsen J. Cervical spine lesions after road traffic accidents: a systematic review. Spine 2002;27:1934–41. 10.1097/00007632-200209010-00023
    1. Hechelhammer L, Pfirrmann CWA, Zanetti M, et al. . Imaging findings predicting the outcome of cervical facet joint blocks. Eur Radiol 2007;17:959–64. 10.1007/s00330-006-0379-y
    1. Le Clec'h Y, Peterson CK, Brunner F, et al. . Cervical facet joint imaging-guided injections: a comparison of outcomes in patients referred based on imaging findings vs palpation for pain. J Manipulative Physiol Ther 2016;39:480–6. 10.1016/j.jmpt.2016.06.004
    1. Kirpalani D, Mitra R. Cervical facet joint dysfunction: a review. Arch Phys Med Rehabil 2008;89:770–4. 10.1016/j.apmr.2007.11.028
    1. Sapir DA, Gorup JM. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study. Spine 2001;26:E268–73. 10.1097/00007632-200106150-00016
    1. Slipman CW, Lipetz JS, Plastaras CT, et al. . Therapeutic zygapophyseal joint injections for headaches emanating from the C2-3 joint. Am J Phys Med Rehabil 2001;80:182–8. 10.1097/00002060-200103000-00005
    1. Barnsley L. Percutaneous radiofrequency neurotomy for chronic neck pain: outcomes in a series of consecutive patients. Pain Med 2005;6:282–6. 10.1111/j.1526-4637.2005.00047.x
    1. Barnsley L, Lord SM, Wallis BJ, et al. . Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 1994;330:1047–50. 10.1056/NEJM199404143301504
    1. Stovner LJ, Kolstad F, Helde G. Radiofrequency denervation of facet joints C2-C6 in cervicogenic headache: a randomized, double-blind, sham-controlled study. Cephalalgia 2004;24:821–30. 10.1111/j.1468-2982.2004.00773.x
    1. Vasseljen O, Woodhouse A, Bjørngaard JH, et al. . Natural course of acute neck and low back pain in the general population: the HUNT study. Pain 2013;154:1237–44. 10.1016/j.pain.2013.03.032
    1. Vos C, Verhagen A, Passchier J, et al. . Management of acute neck pain in general practice: a prospective study. Br J Gen Pract 2007;57:23–8.
    1. Gustavsson C, Denison E, von Koch L. Self-management of persistent neck pain: two-year follow-up of a randomized controlled trial of a multicomponent group intervention in primary health care. Spine 2011;36:2105–15. 10.1097/BRS.0b013e3182028b04
    1. Walker MJ, Boyles RE, Young BA, et al. . The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine 2008;33:2371–8. 10.1097/BRS.0b013e318183391e
    1. Gross A, Kay TM, Paquin J-P, et al. . Exercises for mechanical neck disorders. Cochrane Database Syst Rev 2015;1:CD004250. 10.1002/14651858.CD004250.pub5
    1. Bertozzi L, Gardenghi I, Turoni F, et al. . Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Phys Ther 2013;93:1026–36. 10.2522/ptj.20120412
    1. Sihawong R, Janwantanakul P, Sitthipornvorakul E, et al. . Exercise therapy for office workers with nonspecific neck pain: a systematic review. J Manipulative Physiol Ther 2011;34:62–71. 10.1016/j.jmpt.2010.11.005
    1. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc 2015;90:284–99. 10.1016/j.mayocp.2014.09.008
    1. Berry H, Liyanage SP, Durance RA, et al. . A double-blind study of benorylate and chlormezanone in musculoskeletal disease. Rheumatol Rehabil 1981;20:46–9. 10.1093/rheumatology/20.1.46
    1. Borenstein DG, Korn S. Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: results of two placebo-controlled trials. Clin Ther 2003;25:1056–73. 10.1016/s0149-2918(03)80067-x
    1. Bronfort G, Evans R, Anderson AV, et al. . Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med 2012;156:1–10. 10.7326/0003-4819-156-1-201201030-00002
    1. Hsieh L-F, Hong C-Z, Chern S-H, et al. . Efficacy and side effects of diclofenac patch in treatment of patients with myofascial pain syndrome of the upper trapezius. J Pain Symptom Manage 2010;39:116–25. 10.1016/j.jpainsymman.2009.05.016
    1. Headache Classification Committee of the International Headache Society (IHS) . The International classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013;33:629–808. 10.1177/0333102413485658
    1. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009;8:959–68. 10.1016/S1474-4422(09)70209-1
    1. Borusiak P, Biedermann H, Bosserhoff S, et al. . Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: results of a prospective, randomized, placebo-controlled, and blinded trial. Headache 2010;50:224–30. 10.1111/j.1526-4610.2009.01550.x
    1. Haas M, Spegman A, Peterson D, et al. . Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 2010;10:117–28. 10.1016/j.spinee.2009.09.002
    1. Hall T, Chan HT, Christensen L, et al. . Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther 2007;37:100–7. 10.2519/jospt.2007.2379
    1. Jull G, Trott P, Potter H, et al. . A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27:1835–43. 10.1097/00007632-200209010-00004
    1. Nilsson N. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1995;18:435–40.
    1. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997;20:326–30.
    1. Rathmell JP, Manion SC. The role of image guidance in improving the safety of pain treatment. Curr Pain Headache Rep 2012;16:9–18. 10.1007/s11916-011-0241-z
    1. Abrecht CR, Saba R, Greenberg P, et al. . A contemporary medicolegal analysis of outpatient interventional pain procedures: 2009-2016. Anesth Analg 2019;129:255–62. 10.1213/ANE.0000000000004096
    1. Manchikanti L, Malla Y, Wargo BW, et al. . Complications of fluoroscopically directed facet joint nerve blocks: a prospective evaluation of 7,500 episodes with 43,000 nerve blocks. Pain Physician 2012;15:E143–50.
    1. Heckmann JG, Maihöfner C, Lanz S, et al. . Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance. Clin Neurol Neurosurg 2006;108:709–11. 10.1016/j.clineuro.2005.07.002
    1. Fitzgibbon DR, Posner KL, Domino KB, et al. . Chronic pain management: American Society of Anesthesiologists closed claims project. Anesthesiology 2004;100:98–105. 10.1097/00000542-200401000-00018
    1. Rathmell JP, Michna E, Fitzgibbon DR, et al. . Injury and liability associated with cervical procedures for chronic pain. Anesthesiology 2011;114:918–26. 10.1097/ALN.0b013e31820fc7f2
    1. Purcell-Jones G, Pither CE, Justins DM. Paravertebral somatic nerve block: a clinical, radiographic, and computed tomographic study in chronic pain patients. Anesth Analg 1989;68:32–9.
    1. American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Medicine . Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010;112:810–33. 10.1097/ALN.0b013e3181c43103
    1. Spine Intervention Society . Safety practices for interventional pain procedures. Intra-articular (zygapophysial) joint injections. Available: [Accessed 1 Aug 2021].
    1. Kennedy DJ, Mattie R, Scott Hamilton A, et al. . Detection of intravascular injection during lumbar medial branch blocks: a comparison of aspiration, live fluoroscopy, and digital subtraction technology. Pain Med 2016;17:1031–6. 10.1093/pm/pnv073
    1. Jeon YH, Kim SY. Detection rate of intravascular injections during cervical medial branch blocks: a comparison of digital subtraction angiography and static images from conventional fluoroscopy. Korean J Pain 2015;28:105–8. 10.3344/kjp.2015.28.2.105
    1. Levinson DR. Medicare payments for facet joint injection services, 2008. Department of Health and Human Services Office of Inspector General. Available: [Accessed 12 Nov 2020].
    1. Finlayson RJ, Etheridge J-PB, Vieira L, et al. . A randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block. Reg Anesth Pain Med 2013;38:212–7. 10.1097/AAP.0b013e31828b25bc
    1. Siegenthaler A, Mlekusch S, Trelle S, et al. . Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints. Anesthesiology 2012;117:347–52. 10.1097/ALN.0b013e3182605e11
    1. Siegenthaler A, Schliessbach J, Curatolo M, et al. . Ultrasound anatomy of the nerves supplying the cervical zygapophyseal joints: an exploratory study. Reg Anesth Pain Med 2011;36:606–10. 10.1097/AAP.0b013e3182286af5
    1. U.S. Centers for Medicare and Medicaid Services, Medicare Coverage Database, Local Coverage Determination (LCD) . Facet joint interventions for pain management (L38801). Available:
    1. BlueCross/BlueShield . Diagnosis and treatment of facet joint pain. Corporate Medical Policy. Available: [Accessed 1 Aug 2021].
    1. Cigna Medical Coverage Policies . Musculoskeletal facet joint injections/medial branch blocks. CMM 201.4: non-indications. Available: [Accessed 1 Aug 2021].
    1. UnitedHealthcare Commercial Medical Policy . Epidural steroid and facet joint injections for spinal pain. policy number: 2019T0004FF. Available: [Accessed 1 Aug 2021].
    1. Obernauer J, Galiano K, Gruber H, et al. . Ultrasound-guided versus computed tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial. Med Ultrason 2013;15:10–15. 10.11152/mu.2013.2066.151.jo1ugc2
    1. Eichenberger U, Greher M, Kapral S, et al. . Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology 2006;104:303–8. 10.1097/00000542-200602000-00016
    1. Park KD, Lim D-J, Lee WY, et al. . Ultrasound versus fluoroscopy-guided cervical medial branch block for the treatment of chronic cervical facet joint pain: a retrospective comparative study. Skeletal Radiol 2017;46:81–91. 10.1007/s00256-016-2516-2
    1. Paredes S, Finlayson RJ, Narouze S. Ultrasound-guided cervical medial branch blocks: a systematic review and meta-analysis. Ann Head Med 2020;03.
    1. Finlayson RJ, Etheridge J-PB, Tiyaprasertkul W, et al. . A randomized comparison between ultrasound- and fluoroscopy-guided C7 medial branch block. Reg Anesth Pain Med 2015;40:52–7. 10.1097/AAP.0000000000000186
    1. Park D, Seong MY, Kim HY, et al. . Spinal cord injury during ultrasound-guided C7 cervical medial branch block. Am J Phys Med Rehabil 2017;96:e111–4. 10.1097/PHM.0000000000000613
    1. McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery 1999;45:61–7. 10.1097/00006123-199907000-00015
    1. Narouze SN, Provenzano DA. Sonographically guided cervical facet nerve and joint injections: why sonography? J Ultrasound Med 2013;32:1885–96. 10.7863/ultra.32.11.1885
    1. Siegenthaler A, Eichenberger U, Curatolo M. A shortened radiofrequency denervation method for cervical zygapophysial joint pain based on ultrasound localization of the nerves. Pain Med 2011;12:1703–9. 10.1111/j.1526-4637.2011.01275.x
    1. Khan M, Meleka S. CT guided cervical medial branch block and radiofrequency ablation. J Clin Neurosci 2020;78:393–6. 10.1016/j.jocn.2020.05.009
    1. Finlayson RJ, Gupta G, Alhujairi M, et al. . Cervical medial branch block: a novel technique using ultrasound guidance. Reg Anesth Pain Med 2012;37:219–23. 10.1097/AAP.0b013e3182374e24
    1. Narouze SN. Ultrasound-guided cervical spine injections: ultrasound “prevents” whereas contrast fluoroscopy “detects” intravascular injections. Reg Anesth Pain Med 2012;37:127–30. 10.1097/AAP.0b013e31823f3c80
    1. Won SJ, Lee U-Y, Cho SU, et al. . Feasibility of ultrasound guided atlanto-occipital joint injection. Ann Rehabil Med 2012;36:627–32. 10.5535/arm.2012.36.5.627
    1. Narouze SN. Atlanto-axial and atlanto-occipital joints injection in the treatment of headaches and neck pain. In: Deer TR, Leong MS, Buvanendran A, eds. Comprehensive treatment of chronic pain by medical, interventional, and integrative approaches: the American Academy of Pain Medicine textbook on patient management. 1st edn. New York, NY: Springer, 2013: 297–302.
    1. Narouze SN. Interventional management of head and face pain: nerve blocks and beyond. New York: Springer, 2014.
    1. Centeno C, Williams CJ, Markle J, et al. . A new atlanto-occipital (C0-C1) joint injection technique. Pain Med 2018;19:1499–500. 10.1093/pm/pnx256
    1. Dreyfuss P, Rogers J, Dreyer S, et al. . Atlanto-occipital joint pain. A report of three cases and description of an intraarticular joint block technique. Reg Anesth 1994;19:344–51.
    1. Chevrot A, Cermakova E, Vallée C, et al. . C1-2 arthrography. Skeletal Radiol 1995;24:425–9. 10.1007/BF00941238
    1. Mellström A, Grepe A, Levander B. Atlantoaxial arthrography. A postmortem study. Neuroradiology 1980;20:135–44. 10.1007/BF00341778
    1. Elgueta MF, Ortiz Jimenez J, Wang NN, et al. . Anatomical variations of the vertebral artery in the upper cervical spine: clinical relevance for procedures targeting the C1/C2 and C2/C3 joints. Reg Anesth Pain Med 2018;43:367–71. 10.1097/AAP.0000000000000734
    1. Aiudi CM, Hooten WM, Sanders RA, et al. . Outcomes of C1-2 joint injections. J Pain Res 2017;10:2263–9. 10.2147/JPR.S144255
    1. International Spine Intervention Society . Cervical medial branch thermal radiofrequency neurotomy. In: Bogduk N, ed. Practice guidelines for spinal diagnostic and treatment procedures. 2nd edn. San Francisco, 2013: 133–76.
    1. Lee D-G, Cho Y-W, Jang S-H, et al. . Effectiveness of intra-articular steroid injection for atlanto-occipital joint pain. Pain Med 2015;16:1077–82. 10.1111/pme.12474
    1. El Abd OH, Rosenberg D, Gomba L, et al. . The lateral atlanto-axial joint as a source of headache in congenital atlanto-occipital fusion. Am J Phys Med Rehabil 2008;87:232–7. 10.1097/PHM.0b013e3181619388
    1. Zhou L, Hud-Shakoor Z, Hennessey C, et al. . Upper cervical facet joint and spinal rami blocks for the treatment of cervicogenic headache. Headache 2010;50:657–63. 10.1111/j.1526-4610.2010.01623.x
    1. Busch E, Wilson PR. Atlanto-occipital and atlanto-axial injections in the treatment of headache and neck pain. Reg Anesth 1989;14:45.
    1. Kuklo TR, Riew KD, Orchowski JR, et al. . Management of recalcitrant osteoarthritis of the atlanto-axial joint. Orthopedics 2006;29:633–8. 10.3928/01477447-20060701-06
    1. Lamer TJ. Ear pain due to cervical spine arthritis: treatment with cervical facet injection. Headache 1991;31:682–3. 10.1111/j.1526-4610.1991.hed3110682.x
    1. Shin SM, Kwak SG, Lee DG, et al. . Clinical effectiveness of intra-articular pulsed radiofrequency compared to intra-articular corticosteroid injection for management of atlanto-occipital joint pain: a prospective randomized controlled pilot study. Spine 2018;43:741–6. 10.1097/BRS.0000000000002414
    1. Glémarec J, Guillot P, Laborie Y, et al. . Intraarticular glucocorticosteroid injection into the lateral atlantoaxial joint under fluoroscopic control. A retrospective comparative study in patients with mechanical and inflammatory disorders. Joint Bone Spine 2000;67:54–61.
    1. Hetta DF, Elawamy AM, Hassanein MM, et al. . Efficacy of atlantoaxial joint glucocorticoid injection in patients with rheumatoid arthritis: a randomized trial. Pain Physician 2019;22:E295–302.
    1. Shanthanna H, Busse J, Wang L, et al. . Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2020;125:779–801. 10.1016/j.bja.2020.06.062
    1. Narouze S. Complications of head and neck procedures. Techniques Reg Anesth Pain Manage 2007;11:171–7. 10.1053/j.trap.2007.05.011
    1. McNabney C, Chavda A, Alabsi H, et al. . Anatomic considerations for injection of the lateral atlanto-axial joint. Pain Med 2019;20:2115–9. 10.1093/pm/pnz137
    1. Okubadejo GO, Talcott MR, Schmidt RE, et al. . Perils of intravascular methylprednisolone injection into the vertebral artery: an animal study. J Bone Joint Surg Am 2008;90:1932–8. 10.2106/JBJS.G.01182
    1. Edlow BL, Wainger BJ, Frosch MP, et al. . Posterior circulation stroke after C1-C2 intraarticular facet steroid injection: evidence for diffuse microvascular injury. Anesthesiology 2010;112:1532–5. 10.1097/ALN.0b013e3181d7b15a
    1. Tang E. Complications of C1-C2 facet injection. Anesthesiology 2011;114:222–4. 10.1097/ALN.0b013e3182016655
    1. Datta S, Manchikanti L. It is time to abandon atlanto-axial joint injections: do no harm! Anesthesiology 2011;114:222–4. 10.1097/ALN.0b013e3182016667
    1. Jasper JF. Role of digital subtraction fluoroscopic imaging in detecting intravascular injections. Pain Physician 2003;6:369–72.
    1. Van Boxem K, Rijsdijk M, Hans G, et al. . Safe use of epidural corticosteroid injections: recommendations of the WIP Benelux Work Group. Pain Pract 2019;19:61–92. 10.1111/papr.12709
    1. Reid PJ, Holman PJ. Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report. J Neurosurg Spine 2007;7:664–8. 10.3171/SPI-07/12/664
    1. Spine Intervention Society . Safety practices for interventional pain procedures. Facet interventions: medical branch blocks. Available: [Accessed 27 Nov 2020].
    1. Lee YI, Soh HJ, Kim ED. Postdural puncture headache after cervical medial branch block. Soonchunhyang Med Sci 2018;24:196–8. 10.15746/sms.18.037
    1. Schneider B, Popescu A, Smith C. Ultrasound imaging for cervical injections. Pain Med 2020;21:196–7. 10.1093/pm/pnz277
    1. Wahezi SE, Molina JJ, Alexeev E, et al. . Cervical medial branch block volume dependent dispersion patterns as a predictor for ablation success: a cadaveric study. PM R 2019;11:631–9. 10.1016/j.pmrj.2018.10.003
    1. Barnsley L, Lord S, Wallis B, et al. . False-positive rates of cervical zygapophysial joint blocks. Clin J Pain 1993;9:124–30. 10.1097/00002508-199306000-00007
    1. Lord SM, Barnsley L, Bogduk N. The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain 1995;11:208–13. 10.1097/00002508-199509000-00008
    1. Stojanovic MP, Dey D, Hord ED, et al. . A prospective crossover comparison study of the single-needle and multiple-needle techniques for facet-joint medial branch block. Reg Anesth Pain Med 2005;30:484–90. 10.1016/j.rapm.2005.05.007
    1. Tubbs RS, Mortazavi MM, Loukas M, et al. . Anatomical study of the third occipital nerve and its potential role in occipital headache/neck pain following midline dissections of the craniocervical junction. J Neurosurg Spine 2011;15:71–5. 10.3171/2011.3.SPINE10854
    1. Carr CM, Plastaras CT, Pingree MJ, et al. . Immediate adverse events in interventional pain procedures: a multi-institutional study. Pain Med 2016;17:2155–61. 10.1093/pm/pnw051
    1. Lee H-I, Park Y-S, Cho T-G, et al. . Transient adverse neurologic effects of spinal pain blocks. J Korean Neurosurg Soc 2012;52:228–33. 10.3340/jkns.2012.52.3.228
    1. Verrills P, Mitchell B, Vivian D, et al. . The incidence of intravascular penetration in medial branch blocks: cervical, thoracic, and lumbar spines. Spine 2008;33:E174–7. 10.1097/BRS.0b013e318166f03d
    1. Dreyfuss P, Schwarzer AC, Lau P, et al. . Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine 1997;22:895–902. 10.1097/00007632-199704150-00013
    1. Triffterer L, Machata A-M, Latzke D, et al. . Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics. Br J Anaesth 2012;108:670–4. 10.1093/bja/aer502
    1. Rosenberg PH, Saramies L, Alila A. Lumbar epidural anaesthesia with bupivacaine in old patients: effect of speed and direction of injection. Acta Anaesthesiol Scand 1981;25:270–4. 10.1111/j.1399-6576.1981.tb01649.x
    1. Gomes S, Drakidis A, Silva P, et al. . Spread of fluid: role of tip configurations in needles. Skin Res Technol 2018;24:235–41. 10.1111/srt.12419
    1. Choi J, Kim N, Smuck M, et al. . Effect of injectate viscosity on epidural distribution in lumbar transforaminal epidural steroid injection. Pain Res Manag 2019;2019:2651504. 10.1155/2019/2651504
    1. Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine 1982;7:319–30. 10.1097/00007632-198207000-00001
    1. Sim WS, Park HJ, Kwon JH, et al. . Fluoroscopic evaluation of the influence of needle gauge on epidural spread in caudal block. Medicine 2019;98:e15896. 10.1097/MD.0000000000015896
    1. Lord SM, McDonald GJ, Bogduk N. Percutaneous radiofrequency neurotomy of the cervical medial branches: a validated treatment for cervical zygapophysial joint pain. Neurosurg Quart 1998;8:288–308.
    1. Kweon TD, Kim JY, Lee HY, et al. . Anatomical analysis of medial branches of dorsal rami of cervical nerves for radiofrequency thermocoagulation. Reg Anesth Pain Med 2014;39:465–71. 10.1097/AAP.0000000000000175
    1. Dory MA. Arthrography of the cervical facet joints. Radiology 1983;148:379–82. 10.1148/radiology.148.2.6867328
    1. Dory MA. Arthrography of the lumbar facet joints. Radiology 1981;140:23–7. 10.1148/radiology.140.1.6454162
    1. Jung MW, Schellhas K, Johnson B. Use of diagnostic injections to evaluate sacroiliac joint pain. Int J Spine Surg 2020;14:30–4. 10.14444/6081
    1. Cohen SP, Hurley RW. The ability of diagnostic spinal injections to predict surgical outcomes. Anesth Analg 2007;105:1756–75. 10.1213/01.ane.0000287637.30163.a2
    1. Cosman ER, Dolensky JR, Hoffman RA. Factors that affect radiofrequency heat lesion size. Pain Med 2014;15:2020–36. 10.1111/pme.12566
    1. Kellgren J. On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clin Sci 1939;4:35.
    1. Wahezi SE, Alexeev E, Georgy JS, et al. . Lumbar medial branch block volume-dependent dispersion patterns as a predictor for ablation success: a cadaveric study. PM R 2018;10:616–22. 10.1016/j.pmrj.2017.11.011
    1. Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine 2008;33:1291–7. 10.1097/BRS.0b013e31817329f0
    1. Tekin I, Mirzai H, Ok G, et al. . A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain 2007;23:524–9. 10.1097/AJP.0b013e318074c99c
    1. van Kleef M, Barendse GA, Kessels A, et al. . Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999;24:1937–42. 10.1097/00007632-199909150-00013
    1. Cohen SP, Doshi TL, Constantinescu OC, et al. . Effectiveness of lumbar facet joint blocks and predictive value before radiofrequency denervation: the facet treatment study (FACTS), a randomized, controlled clinical trial. Anesthesiology 2018;129:517–35. 10.1097/ALN.0000000000002274
    1. Hussain A, Usmani H, Huda MF. Comparison of cervical medial branch nerve block versus trigger point injection in patients with chronic neck pain. Indian J Pain 2020;34:27–33.
    1. Manchikanti L, Singh V, Falco FJE, et al. . Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci 2010;7:124–35. 10.7150/ijms.7.124
    1. Manchikanti L, Singh V, Falco FJE, et al. . Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine 2008;33:1813–20. 10.1097/BRS.0b013e31817b8f88
    1. Rocha IDda, Cristante AF, Marcon RM, et al. . Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics 2014;69:529–34. 10.6061/clinics/2014(08)05
    1. Sutton T. Hoarseness following cervical facet denervation: a case report. J Pain 2011;12:P17. 10.1016/j.jpain.2011.02.069
    1. Wahezi SE, Silva K, Shaparin N, et al. . Currently recommended TON injectate volumes concomitantly block the GON: clinical implications for managing cervicogenic headache. Pain Physician 2016;19:E1079–86.
    1. Finlayson RJ, Etheridge J-PB, Tiyaprasertkul W, et al. . A prospective validation of biplanar ultrasound imaging for C5-C6 cervical medial branch blocks. Reg Anesth Pain Med 2014;39:160–3. 10.1097/AAP.0000000000000043
    1. Finlayson RJ, Thonnagith A, Elgueta MF, et al. . Ultrasound-guided cervical medial branch radiofrequency neurotomy: can multitined deployment cannulae be the solution? Reg Anesth Pain Med 2017;42:45–51. 10.1097/AAP.0000000000000506
    1. Park S-C, Kim K-H. 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. J Anesth 2012;26:738–45. 10.1007/s00540-012-1404-8
    1. Bureau NJ, Moser TP, Gouvion A, et al. . CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome. Eur Radiol 2020;30:5933–41. 10.1007/s00330-020-06974-8
    1. Won H-S, Jang H-Y, Moon H-S, et al. . Fluoroscopic findings of extra-cervical facet joint flow and its incidence on cervical facet joint arthrograms. J Clin Med 2020;9:3919. 10.3390/jcm9123919
    1. Cousins MJ, Mather LE. Clinical pharmacology of local anaesthetics. Anaesth Intensive Care 1980;8:257–77. 10.1177/0310057X8000800303
    1. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain 1993;55:99–106. 10.1016/0304-3959(93)90189-V
    1. Arnér S, Lindblom U, Meyerson BA, et al. . Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clinical studies. Pain 1990;43:287–97. 10.1016/0304-3959(90)90026-A
    1. Bisby MA. Inhibition of axonal transport in nerves chronically treated with local anesthetics. Exp Neurol 1975;47:481–9. 10.1016/0014-4886(75)90080-1
    1. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand 2006;50:265–82. 10.1111/j.1399-6576.2006.00936.x
    1. Manchikanti L, Singh V, Falco FJE, et al. . 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;13:437–50.
    1. Hove B, Gyldensted C. Cervical analgesic facet joint arthrography. Neuroradiology 1990;32:456–9. 10.1007/BF02426454
    1. Roy DF, Fleury J, Fontaine SB, et al. . Clinical evaluation of cervical facet joint infiltration. Can Assoc Radiol J 1988;39:118–20.
    1. Lee DW, Huston C. Fluoroscopically-guided cervical zygapophyseal therapeutic joint injections may reduce the need for radiofrequency. Pain Physician 2018;21:E661–5.
    1. Zhang J, Tsuzuki N, Hirabayashi S, et al. . Surgical anatomy of the nerves and muscles in the posterior cervical spine: a guide for avoiding inadvertent nerve injuries during the posterior approach. Spine 2003;28:1379–84. 10.1097/01.BRS.0000067095.75764.D3
    1. Nolan JP, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine 1988;13:9–11. 10.1097/00007632-198801000-00003
    1. Amonoo-Kuofi HS. The density of muscle spindles in the medial, intermediate and lateral columns of human intrinsic postvertebral muscles. J Anat 1983;136:509–19.
    1. Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India 2001;49:355.
    1. McLain RF. Mechanoreceptor endings in human cervical facet joints. Spine 1994;19:495–501. 10.1097/00007632-199403000-00001
    1. Armstrong B, McNair P, Taylor D. Head and neck position sense. Sports Med 2008;38:101–17. 10.2165/00007256-200838020-00002
    1. van Eerd M, Patijn J, Lataster A, et al. . Cervical facet pain. Pain Pract 2010;10:113–23. 10.1111/j.1533-2500.2009.00346.x
    1. Kettler A, Werner K, Wilke H-J. Morphological changes of cervical facet joints in elderly individuals. Eur Spine J 2007;16:987–92. 10.1007/s00586-006-0275-9
    1. Ahmed MM, Lake WB, Resnick DK. Progressive severe kyphosis as a complication of multilevel cervical percutaneous facet neurotomy: a case report. Spine J 2012;12:e5–8. 10.1016/j.spinee.2012.09.037
    1. Stoker GE, Buchowski JM, Kelly MP. Dropped head syndrome after multilevel cervical radiofrequency ablation: a case report. J Spinal Disord Tech 2013;26:444–8. 10.1097/BSD.0b013e31825c36c0
    1. Curatolo M, Bogduk N. Diagnostic blocks for chronic pain. Scand J Pain 2010;1:186–92. 10.1016/j.sjpain.2010.07.001
    1. National Cancer Institute . NCI dictionary of cancer terms. Available: [Accessed 1 Apr 2019].
    1. Hogan QH, Abram SE, Hogan Quinn H. Neural blockade for diagnosis and prognosis. A review. Anesthesiology 1997;86:216–41. 10.1097/00000542-199701000-00026
    1. de Craen AJ, Tijssen JG, de Gans J, et al. . Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos. J Neurol 2000;247:183–8. 10.1007/s004150050560
    1. Thomas M, Eriksson SV, Lundeberg T. A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Am J Chin Med 1991;19:95–100. 10.1142/S0192415X91000156
    1. Freire V, Grabs D, Lepage-Saucier M, et al. . Ultrasound-guided cervical facet joint injections: a viable substitution for fluoroscopy-guided injections? J Ultrasound Med 2016;35:1253–8. 10.7863/ultra.15.07062
    1. Bogduk N. A commentary on appropriate use criteria for sacroiliac pain. Pain Med 2017;18:2055–7. 10.1093/pm/pnx234
    1. Kaplan M, Dreyfuss P, Halbrook B, et al. . The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint. A physiologic challenge. Spine 1998;23:1847–52. 10.1097/00007632-199809010-00008
    1. Terry MJ, Moeschler SM, Hoelzer BC, et al. . Pain catastrophizing and anxiety are associated with heat pain perception in a community sample of adults with chronic pain. Clin J Pain 2016;32:875–81. 10.1097/AJP.0000000000000333
    1. Cohen SP, Mullings R, Abdi S. The pharmacologic treatment of muscle pain. Anesthesiology 2004;101:495–526. 10.1097/00000542-200408000-00032
    1. Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del Moral O, et al. . Prevalence of myofascial pain syndrome in chronic non-specific neck pain: a population-based cross-sectional descriptive study. Pain Med 2016;17:2369–77. 10.1093/pm/pnw114
    1. Walega DR, Kendall MC, Nagpal G, et al. . Evaluation of anxiety in procedure-naive patients during cervical and lumbar epidural steroid injection procedures. Reg Anesth Pain Med 2015;40:255–61. 10.1097/AAP.0000000000000238
    1. Trentman TL, Rosenfeld DM, Seamans DP, et al. . Vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections. Pain Pract 2009;9:59–64. 10.1111/j.1533-2500.2008.00242.x
    1. Kennedy DJ, Schneider B, Smuck M, et al. . The use of moderate sedation for the secondary prevention of adverse vasovagal reactions. Pain Med 2015;16:673–9. 10.1111/pme.12632
    1. Liu F, Fang T, Zhou F, et al. . Association of depression/anxiety symptoms with neck pain: a systematic review and meta-analysis of literature in China. Pain Res Manag 2018;2018:3259431:1–9. 10.1155/2018/3259431
    1. Rees CS, Smith AJ, O'Sullivan PB, et al. . Back and neck pain are related to mental health problems in adolescence. BMC Public Health 2011;11:382. 10.1186/1471-2458-11-382
    1. Manchikanti L, Pampati V, Damron KS, et al. . A randomized, prospective, double-blind, placebo-controlled evaluation of the effect of sedation on diagnostic validity of cervical facet joint pain. Pain Physician 2004;7:301–9.
    1. Manchikanti L, Pampati V, Damron KS, et al. . The effect of sedation on diagnostic validity of facet joint nerve blocks: an evaluation to assess similarities in population with involvement in cervical and lumbar regions (ISRCTNo: 76376497). Pain Physician 2006;9:47–51.
    1. Cohen SP, Hameed H, Kurihara C, et al. . The effect of sedation on the accuracy and treatment outcomes for diagnostic injections: a randomized, controlled, crossover study. Pain Med 2014;15:588–602. 10.1111/pme.12389
    1. Dreyfuss P, Cohen S, Chen AS, et al. . Is immediate pain relief after a spinal injection procedure enhanced by intravenous sedation? PM R 2009;1:60–3. 10.1016/j.pmrj.2008.10.006
    1. Erdek MA, Halpert DE, González Fernández M, et al. . Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain. Pain Med 2010;11:92–100. 10.1111/j.1526-4637.2009.00756.x
    1. Chen Y, Vu T-NH, Chinchilli VM, et al. . Clinical and technical factors associated with knee radiofrequency ablation outcomes: a multicenter analysis. Reg Anesth Pain Med 2021;46:298–304. 10.1136/rapm-2020-102017
    1. Cucuzzella TR, Delport EG, Kim N, et al. . A survey: conscious sedation with epidural and zygapophyseal injections: is it necessary? Spine J 2006;6:364–9. 10.1016/j.spinee.2005.09.005
    1. Kim N, Delport E, Cucuzzella T, et al. . Is sedation indicated before spinal injections? Spine 2007;32:E748–52. 10.1097/BRS.0b013e31815b7e9f
    1. American Society of Anesthesiologists (ASA) . Statement on anesthetic care during interventional pain procedures for adults, 2019. Available: [Accessed 1 Aug 2021].
    1. Neal JM, Barrington MJ, Brull R, et al. . The second ASRA Practice Advisory on neurologic complications associated with regional anesthesia and pain medicine: Executive summary 2015. Reg Anesth Pain Med 2015;40:401–30. 10.1097/AAP.0000000000000286
    1. Spine Intervention Society . Conscious sedation. Available: [Accessed 1 Aug 2021].
    1. Cohen SP, Strassels SA, Kurihara C, et al. . Establishing an optimal “cutoff” threshold for diagnostic lumbar facet blocks: a prospective correlational study. Clin J Pain 2013;29:382–91. 10.1097/AJP.0b013e31825f53bf
    1. Manchikanti L, Pampati S, Cash KA. Making sense of the accuracy of diagnostic lumbar facet joint nerve blocks: an assessment of the implications of 50% relief, 80% relief, single block, or controlled diagnostic blocks. Pain Physician 2010;13:133–43.
    1. Derby R, Melnik I, Lee J-E, et al. . Correlation of lumbar medial branch neurotomy results with diagnostic medial branch block cutoff values to optimize therapeutic outcome. Pain Med 2012;13:1533–46. 10.1111/j.1526-4637.2012.01500.x
    1. Cohen SP, Huang JHY, Brummett C. Facet joint pain-advances in patient selection and treatment. Nat Rev Rheumatol 2013;9:101–16. 10.1038/nrrheum.2012.198
    1. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013;9:216–24. 10.1038/nrrheum.2012.199
    1. McLain RF, Pickar JG. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine 1998;23:168–73. 10.1097/00007632-199801150-00004
    1. Bogduk N, Aprill C. On the nature of neck pain, discography and cervical zygapophysial joint blocks. Pain 1993;54:213–7. 10.1016/0304-3959(93)90211-7
    1. Kumar S, Narayan Y, Prasad N, et al. . Cervical electromyogram profile differences between patients of neck pain and control. Spine 2007;32:E246–53. 10.1097/01.brs.0000259927.85981.31
    1. Ribeiro DC, Belgrave A, Naden A, et al. . The prevalence of myofascial trigger points in neck and shoulder-related disorders: a systematic review of the literature. BMC Musculoskelet Disord 2018;19:252. 10.1186/s12891-018-2157-9
    1. Dworkin RH, Turk DC, Wyrwich KW, et al. . Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 2008;9:105–21. 10.1016/j.jpain.2007.09.005
    1. Cohen SP, Hayek S, Semenov Y, et al. . Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: a multicenter, randomized, comparative-effectiveness study. Anesthesiology 2014;121:1045–55. 10.1097/ALN.0000000000000409
    1. Juch JNS, Maas ET, Ostelo RWJG, et al. . Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the mint randomized clinical trials. JAMA 2017;318:68–81. 10.1001/jama.2017.7918
    1. Predel H-G, Ebel-Bitoun C, Peil B, et al. . Efficacy and safety of diclofenac + capsaicin gel in patients with acute back/neck pain: a multicenter randomized controlled study. Pain Ther 2020;9:279–96. 10.1007/s40122-020-00161-9
    1. Shin W-R, Kim H-I, Shin D-G, et al. . Radiofrequency neurotomy of cervical medial branches for chronic cervicobrachialgia. J Korean Med Sci 2006;21:119–225. 10.3346/jkms.2006.21.1.119
    1. Colloca L. The placebo effect in pain therapies. Annu Rev Pharmacol Toxicol 2019;59:191–211. 10.1146/annurev-pharmtox-010818-021542
    1. Carette S, Leclaire R, Marcoux S, et al. . Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336:1634–40. 10.1056/NEJM199706053362303
    1. Friedly JL, Comstock BA, Turner JA, et al. . A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11–21. 10.1056/NEJMoa1313265
    1. Gilron I, Carr DB, Desjardins PJ, et al. . Current methods and challenges for acute pain clinical trials. Pain Rep 2019;4:e647. 10.1097/PR9.0000000000000647
    1. Reckziegel D, Vachon-Presseau E, Petre B, et al. . Deconstructing biomarkers for chronic pain: context- and hypothesis-dependent biomarker types in relation to chronic pain. Pain 2019;160 Suppl 1:S37–48. 10.1097/j.pain.0000000000001529
    1. Cohen SP, Atanelov L, Rammasubu C, et al. . Can changes in vital signs be used to predict the response to lumbar facet blocks and radiofrequency denervation? A prospective, correlational study. Reg Anesth Pain Med 2014;39:333–40. 10.1097/AAP.0000000000000105
    1. Gellhorn AC. Cervical facet-mediated pain. Phys Med Rehabil Clin N Am 2011;22:447–58. 10.1016/j.pmr.2011.02.006
    1. Gazelka HM, Knievel S, Mauck WD, et al. . Incidence of neuropathic pain after radiofrequency denervation of the third occipital nerve. J Pain Res 2014;7:195–8. 10.2147/JPR.S60925
    1. Cohen SP, Hurley RW, Christo PJ, et al. . Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain 2007;23:45–52. 10.1097/01.ajp.0000210941.04182.ea
    1. Royal MA, Bhakta B, Gunyea I, et al. . Radiofrequency neurolysis for facet arthropathy: a retrospective case series and review of the literature. Pain Pract 2002;2:47–52. 10.1046/j.1533-2500.2002.02004.x
    1. Smuck M, Crisostomo RA, Trivedi K, et al. . Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R 2012;4:686–92. 10.1016/j.pmrj.2012.06.007
    1. Tzaan WC, Tasker RR. Percutaeous radiofrequency facet rhizotomy-experience with 118 procdedures and reappraisal of its value. Can J Neurol Sci 2000;27:125–30.
    1. van 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. 10.1111/papr.12043
    1. Derby R, Melnik I, Choi J, et al. . Indications for repeat diagnostic medial branch nerve blocks following a failed first medial branch nerve block. Pain Physician 2013;16:479–88.
    1. Cohen SP, Moon JY, Brummett CM, et al. . Medial branch blocks or intra-articular injections as a prognostic tool before lumbar facet radiofrequency denervation: a multicenter, case-control study. Reg Anesth Pain Med 2015;40:376–83. 10.1097/AAP.0000000000000229
    1. Stojanovic MP, Sethee J, Mohiuddin M, et al. . MRI analysis of the lumbar spine: can it predict response to diagnostic and therapeutic facet procedures? Clin J Pain 2010;26:110–5. 10.1097/AJP.0b013e3181b8cd4d
    1. Cohen SP, Williams KA, Kurihara C, et al. . Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology 2010;113:395–405. 10.1097/ALN.0b013e3181e33ae5
    1. MacVicar J, Borowczyk JM, MacVicar AM, et al. . Lumbar medial branch radiofrequency neurotomy in New Zealand. Pain Med 2013;14:639–45. 10.1111/pme.12000
    1. McCormick ZL, Reddy R, Korn M, et al. . A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis. Pain Med 2018;19:1628–38. 10.1093/pm/pnx286
    1. van Suijlekom HA, van Kleef M, Barendse GA, et al. . Radiofrequency cervical zygapophyseal joint neurotomy for cervicogenic headache: a prospective study of 15 patients. Funct Neurol 1998;13:297–303.
    1. Hamer JF, Purath TA. Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve. Headache 2014;54:500–10. 10.1111/head.12295
    1. Govind J, King W, Bailey B, et al. . Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry 2003;74:88–93. 10.1136/jnnp.74.1.88
    1. National Institutes of Health . Federal pain research strategy. Available: [Accessed 1 Aug 2021].
    1. Cheng J, Gutenberg LV, Dalton JE. Comparative long-term outcomes of lateral versus posterior approach to cervical facet medial branch radiofrequency ablation. (American Academy of Pain Medicine 2013 Meeting abstract #179). Pain Med 2013;14:586.
    1. Bogduk N, Macintosh J, Marsland A. Technical limitations to the efficacy of radiofrequency neurotomy for spinal pain. Neurosurgery 1987;20:529–35. 10.1227/00006123-198704000-00004
    1. van Eerd M, Lataster A, Sommer M, et al. . A modified posterolateral approach for radiofrequency denervation of the medial branch of the cervical segmental nerve in cervical facet joint pain based on anatomical considerations. Pain Pract 2017;17:596–603. 10.1111/papr.12499
    1. Lord SM, Barnsley L, Bogduk N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Neurosurgery 1995;36:732–9. 10.1227/00006123-199504000-00014
    1. Klessinger S. Radiofrequency neurotomy for the treatment of therapy-resistant neck pain after ventral cervical operations. Pain Med 2010;11:1504–10. 10.1111/j.1526-4637.2010.00942.x
    1. Little JS, Ianuzzi A, Chiu JB, et al. . Human lumbar facet joint capsule strains: II. Alteration of strains subsequent to anterior interbody fixation. Spine J 2004;4:153–62. 10.1016/j.spinee.2003.07.002
    1. Lang JK, Buchfelder M. Radiofrequency neurotomy for headache stemming from the zygapophysial joints C2/3 and C3/4. Cent Eur Neurosurg 2010;71:75–9. 10.1055/s-0029-1224159
    1. Ellwood S, Shupper P, Kaufman A. A retrospective review of spinal radiofrequency neurotomy procedures in patients with metallic posterior spinal instrumentation - is it safe? Pain Physician 2018;21:E477–82.
    1. Seichi A, Kimura A, Higashi T, et al. . Localization of the medial branches of the cervical dorsal rami during cervical laminoplasty. Spine 2012;37:E1603–6. 10.1097/BRS.0b013e318274fc5e
    1. Ebraheim NA, Haman ST, Xu R, et al. . The anatomic location of the dorsal ramus of the cervical nerve and its relation to the superior articular process of the lateral mass. Spine 1998;23:1968–71. 10.1097/00007632-199809150-00009
    1. Marks R. Distribution of pain provoked from lumbar facet joints and related structures during diagnostic spinal infiltration. Pain 1989;39:37–40. 10.1016/0304-3959(89)90173-5
    1. Li J, Kong X, Gozani SN, et al. . Current-distance relationships for peripheral nerve stimulation localization. Anesth Analg 2011;112:236–41. 10.1213/ANE.0b013e3181fca16b
    1. Johnson CR, Barr RC, Klein SM. A computer model of electrical stimulation of peripheral nerves in regional anesthesia. Anesthesiology 2007;106:323–30. 10.1097/00000542-200702000-00021
    1. Klein SM, Melton MS, Grill WM, et al. . Peripheral nerve stimulation in regional anesthesia. Reg Anesth Pain Med 2012;37:383–92. 10.1097/AAP.0b013e3182576647
    1. Cohen SP, Strassels SA, Kurihara C, et al. . Does sensory stimulation threshold affect lumbar facet radiofrequency denervation outcomes? A prospective clinical correlational study. Anesth Analg 2011;113:1233–41. 10.1213/ANE.0b013e31822dd379
    1. Brendler SJ. The human cervical myotomes: functional anatomy studied at operation. J Neurosurg 1968;28:105–11. 10.3171/jns.1968.28.2.0105
    1. Dreyfuss P, Halbrook B, Pauza K, et al. . Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000;25:1270–7. 10.1097/00007632-200005150-00012
    1. Koh JC, Kim DH, Lee YW, et al. . Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy. Korean J Pain 2017;30:296–303. 10.3344/kjp.2017.30.4.296
    1. Dreyfuss P, Stout A, Aprill C, et al. . The significance of multifidus atrophy after successful radiofrequency neurotomy for low back pain. PM R 2009;1:719–22. 10.1016/j.pmrj.2009.05.014
    1. Paterno J, Rathmell JP, Gilligan C. Cryoanalgesia and radiofrequency ablation. In: Bajwa Z, Wootton RJ, Warfield CA, eds. Principles and practice of pain medicine. 3rd edn. New York: McGraw-Hill Education, 2016.
    1. Bogduk N, Long DM. The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low-back pain. J Neurosurg 1979;51:172–7. 10.3171/jns.1979.51.2.0172
    1. Abbott Z, Smuck M, Haig A, et al. . Irreversible spinal nerve injury from dorsal ramus radiofrequency neurotomy: a case report. Arch Phys Med Rehabil 2007;88:1350–2. 10.1016/j.apmr.2007.07.006
    1. Pait TG, McAllister PV, Kaufman HH. Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg 1995;82:1011–4. 10.3171/jns.1995.82.6.1011
    1. Sangari SK, Heinneman TE, Conti MS, et al. . Quantitative gross and CT measurements of cadaveric cervical vertebrae (C3-C6) as guidelines for the lateral mass screw fixation. Int J Spine Surg 2016;10:43. 10.14444/3043
    1. Xu R, Ebraheim NA, Nadaud MC, et al. . The location of the cervical nerve roots on the posterior aspect of the cervical spine. Spine 1995;20:2267–71. 10.1097/00007632-199511000-00001
    1. Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 1976;39:69–76. 10.1159/000102478
    1. Ball RD. The science of conventional and water-cooled monopolar lumbar radiofrequency rhizotomy: an electrical engineering point of view. Pain Physician 2014;17:E175–211.
    1. Provenzano DA. Think before you inject: understanding electrophysiological radiofrequency principles and the importance of the local tissue environment. Reg Anesth Pain Med 2014;39:269–71. 10.1097/AAP.0000000000000114
    1. Provenzano DA, Cosman ER, Wilsey JT. Hypertonic sodium chloride preinjectate increases in vivo radiofrequency ablation size: histological and magnetic resonance imaging findings. Reg Anesth Pain Med 2018;43:776–88. 10.1097/AAP.0000000000000814
    1. Provenzano DA, Liebert MA, Somers DL. Increasing the NaCl concentration of the preinjected solution enhances monopolar radiofrequency lesion size. Reg Anesth Pain Med 2013;38:112–23. 10.1097/AAP.0b013e31827d18f3
    1. Provenzano DA, Watson TW, Somers DL. The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size. Reg Anesth Pain Med 2015;40:112–24. 10.1097/AAP.0000000000000207
    1. Provenzano DA, Cosman E, Wilsey J. Comparisons of monopolar lesion volumes with hypertonic saline solution in radiofrequency ablation: a randomized, double-blind, ex vivo study. Pain Physician 2020;23:E425–7.
    1. Eckmann MS, Martinez MA, Lindauer S, et al. . Radiofrequency ablation near the bone-muscle interface alters soft tissue lesion dimensions. Reg Anesth Pain Med 2015;40:270–5. 10.1097/AAP.0000000000000221
    1. Kim YN, Rhim H, Choi D, et al. . The effect of radiofrequency ablation on different organs: ex vivo and in vivo comparative studies. Eur J Radiol 2011;80:526–32. 10.1016/j.ejrad.2009.11.011
    1. Provenzano DA, Lutton EM, Somers DL. The effects of fluid injection on lesion size during bipolar radiofrequency treatment. Reg Anesth Pain Med 2012;37:267–76. 10.1097/AAP.0b013e3182493bd8
    1. Provenzano DA, Lassila HC, Somers D. The effect of fluid injection on lesion size during radiofrequency treatment. Reg Anesth Pain Med 2010;35:338–42. 10.1097/aap.0b013e3181e82d44
    1. Zachariah C, Mayeux J, Alas G, et al. . Physiological and functional responses of water-cooled versus traditional radiofrequency ablation of peripheral nerves in rats. Reg Anesth Pain Med 2020;45:792–8. 10.1136/rapm-2020-101361
    1. Smith HP, McWhorter JM, Challa VR. Radiofrequency neurolysis in a clinical model. J Neurosurg 1981;55:246–53. 10.3171/jns.1981.55.2.0246
    1. Podhajsky RJ, Sekiguchi Y, Kikuchi S, et al. . The histologic effects of pulsed and continuous radiofrequency lesions at 42 degrees C to rat dorsal root ganglion and sciatic nerve. Spine 2005;30:1008–13. 10.1097/01.brs.0000161005.31398.58
    1. Choi EJ, Choi YM, Jang EJ, et al. . Neural ablation and regeneration in pain practice. Korean J Pain 2016;29:3–11. 10.3344/kjp.2016.29.1.3
    1. Vallejo R, Benyamin R, Tilley DM, et al. . An ex vivo comparison of cooled-radiofrequency and bipolar-radiofrequency lesion size and the effect of injected fluids. Reg Anesth Pain Med 2014;39:312–21. 10.1097/AAP.0000000000000090
    1. Bogduk N, Dreyfuss P, Baker R, et al. . Complications of spinal diagnostic and treatment procedures. Pain Medicine 2008;9:S11–34. 10.1111/j.1526-4637.2008.00437.x
    1. Cohen SP, Hurley RW, Buckenmaier CC, et al. . Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology 2008;109:279–88. 10.1097/ALN.0b013e31817f4c7c
    1. Gazelka HM, Welch TL, Nassr A, et al. . Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study. Pain Med 2015;16:877–80. 10.1111/pme.12678
    1. Manchikanti L, Hirsch JA, Kaye AD, et al. . Cervical zygapophysial (facet) joint pain: effectiveness of interventional management strategies. Postgrad Med 2016;128:54–68. 10.1080/00325481.2016.1105092
    1. Bureau NJ, Moser T, Dagher JH, et al. . Transforaminal versus intra-articular facet corticosteroid injections for the treatment of cervical radiculopathy: a randomized, double-blind, controlled study. AJNR Am J Neuroradiol 2014;35:1467–74. 10.3174/ajnr.A4026
    1. Rathmell JP, Benzon HT, Dreyfuss P, et al. . Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology 2015;122:974–84. 10.1097/ALN.0000000000000614
    1. Pollak KA, Stephens LS, Posner KL, et al. . Trends in pain medicine liability. Anesthesiology 2015;123:1133–41. 10.1097/ALN.0000000000000855
    1. Dobrogowski J, Wrzosek A, Wordliczek J. Radiofrequency denervation with or without addition of pentoxifylline or methylprednisolone for chronic lumbar zygapophysial joint pain. Pharmacol Rep 2005;57:475–80.
    1. Singh JR, Miccio VF, Modi DJ, et al. . The impact of local steroid administration on the incidence of neuritis following lumbar facet radiofrequency neurotomy. Pain Physician 2019;22:69–74.
    1. Ehsanian R, Rosati RM, Kennedy DJ, et al. . Antiplatelet and anticoagulant risk for select spine interventions: a retrospective cohort. Pain Med 2020;21:910–7. 10.1093/pm/pnaa009
    1. Manchikanti L, Benyamin RM, Swicegood JR, et al. . Assessment of practice patterns of perioperative management of antiplatelet and anticoagulant therapy in interventional pain management. Pain Physician 2012;15:E955–68.
    1. Narouze S, Benzon HT, Provenzano D, et al. . Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition): guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 2018;43:225–62. 10.1097/AAP.0000000000000700
    1. Lee CJ, Kim YC, Shin JH, et al. . Intravascular injection in lumbar medial branch block: a prospective evaluation of 1433 injections. Anesth Analg 2008;106:1274–8. 10.1213/ane.0b013e318162c358
    1. Finlayson RJ, Etheridge J-PB, Chalermkitpanit P, et al. . Real-tme detection of periforaminal vessels in the cervical spine: an ultrasound survey. Reg Anesth Pain Med 2016;41:130–4. 10.1097/AAP.0000000000000363
    1. Endres S, Shufelt A, Bogduk N. The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures. Pain Med 2017;18:403–9. 10.1093/pm/pnw108
    1. Bernstein J, Furman MB, Gilhool L, et al. . The risks of continuing or discontinuing anticoagulants in diverse interventional pain procedures. Pain Med 2018;19:1885–6.
    1. Kuo H-C, Liu F-L, Chen J-T, et al. . Thromboembolic and bleeding risk of periprocedural bridging anticoagulation: a systematic review and meta-analysis. Clin Cardiol 2020;43:441–9. 10.1002/clc.23336
    1. Saffarian M, Lee H, McCormick ZL, Spine Intervention’s Society Patient Safety Committee . Anticoagulants and antiplatelet agents for cervical medial branch radiofrequency neurotomy, 2021. Available: [Accessed 1 Aug 2021].
    1. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015;12:464–74. 10.1038/nrcardio.2015.83
    1. Engel A, Rappard G, King W, et al. . The effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy: a systematic review with comprehensive analysis of the published data. Pain Med 2016;17:658–69. 10.1111/pme.12928
    1. Bicket MC, Chakravarthy K, Chang D, et al. . Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag 2015;5:129–46. 10.2217/pmt.14.53
    1. Welsh S, Varner SM, Hernandez MT, et al. . The role of gabapentin in the prevention of postoperative neuritis following radiofrequency ablation of cervical and lumbar medial branch nerves. Ind J Basic App Med Res 2014;3:501–6.
    1. Ma K, Yiqun M, Wu T, et al. . Efficacy of diclofenac sodium in pain relief after conventional radiofrequency denervation for chronic facet joint pain: a double-blind randomized controlled trial. Pain Med 2011;12:27–35. 10.1111/j.1526-4637.2010.00978.x
    1. Ramos JA. Spinal injection of local anesthetic during cervical facet joint injection. Braz J Anesthesiol 2016;66:654–6. 10.1016/j.bjane.2014.04.004
    1. Smith M, Ferretti G, Mortazavi S. Radiographic changes induced after cervical facet radiofrequency denervation. Spine J 2005;5:668–71. 10.1016/j.spinee.2005.04.006
    1. Roark C, Whicher S, Abosch A. Reversible neurological symptoms caused by diathermy in a patient with deep brain stimulators: case report. Neurosurgery 2008;62:E256. 10.1227/01.NEU.0000311085.73519.B4
    1. Bautista A, Dadabayev A, Rosenquist E, et al. . Bipolar radiofrequency neurotomy to treat neck and back pain in patients with automatic implantable cardioverter defibrillator. Pain Physician 2016;19:E505–9.
    1. Osborne MD. Radiofrequency neurotomy for a patient with deep brain stimulators: proposed safety guidelines. Pain Med 2009;10:1046–9. 10.1111/j.1526-4637.2009.00686.x
    1. American Society of Anesthesiologists . Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Anesthesiology 2011;114:247–61. 10.1097/ALN.0b013e3181fbe7f6
    1. Pfeiffer D, Tebbenjohanns J, Schumacher B, et al. . Pacemaker function during radiofrequency ablation. Pacing Clin Electrophysiol 1995;18:1037–44. 10.1111/j.1540-8159.1995.tb04746.x
    1. Moore S, Firstenberg MS, Trohman RG. Long-term effects of radiofrequency catheter ablation on previously implanted pacemakers. PACE 1993;16:947.
    1. Smith C, DeFrancesch F, Patel J, et al. . Radiofrequency neurotomy for facet joint pain in patients with permanent pacemakers and defibrillators, 2018. Available: [Accessed 26 Aug 2021].
    1. Smith C, DeFrancesch F, Patel J, et al. . Radiofrequency neurotomy for facet joint pain in patients with permanent pacemakers and defibrillators. Pain Med 2019;20:411–2. 10.1093/pm/pny213
    1. Katz SS, Savitz MH. Percutaneous radiofrequency rhizotomy of the lumbar facets. Mt Sinai J Med 1986;53:523–5.
    1. McCormick ZL, Walega DR. Third-degree skin burn from conventional radiofrequency ablation of the inferiomedial genicular nerve. Pain Med 2018;19:1095–7. 10.1093/pm/pnx204
    1. Ogsbury JS, Simon RH, Lehman RAW. Facet “denervation” in the treatment of low back syndrome. Pain 1977;3:257–63. 10.1016/0304-3959(77)90006-9
    1. Burnham T, Hilgenhurst G, McCormick ZL. Second-degree skin burn from a radiofrequency grounding pad: a case report and review of risk-mitigation strategies. PM R 2019;11:1139–42. 10.1002/pmrj.12143
    1. Lamer TJ, Smith J, Hoelzer BC, et al. . Safety of lumbar spine radiofrequency procedures in patients who have posterior spinal hardware. Pain Med 2016;17:1634–7. 10.1093/pm/pnv078
    1. Cohen SP, Wallace M, Rauck RL, et al. . Unique aspects of clinical trials of invasive therapies for chronic pain. Pain Rep 2019;4:e687. 10.1097/PR9.0000000000000687
    1. Husted DS, Orton D, Schofferman J, et al. . Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain. J Spinal Disord Tech 2008;21:406–8. 10.1097/BSD.0b013e318158971f
    1. Bogduk N, Yoganandan N. Biomechanics of the cervical spine. Part 3: Minor injuries. Clin Biomech 2001;16:267–75. 10.1016/s0268-0033(01)00003-1
    1. Crawford JR, Nuffort LE. Defending claims involving future radiofrequency neurotomy treatments. For the defense 2018; October: 64-69. Available: [Accessed 5 Apr 2021].
    1. Speldewinde GC. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med 2011;12:209–18. 10.1111/j.1526-4637.2010.01022.x
    1. Rambaransingh B, Stanford G, Burnham R. The effect of repeated zygapophysial joint radiofrequency neurotomy on pain, disability, and improvement duration. Pain Med 2010;11:1343–7. 10.1111/j.1526-4637.2010.00923.x
    1. McGreevy K, Hurley RW, Erdek MA, et al. . The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract 2013;13:89–95. 10.1111/j.1533-2500.2012.00557.x
    1. Cohen SP, Strassels SA, Kurihara C, et al. . Outcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation. Reg Anesth Pain Med 2009;34:206–14. 10.1097/AAP.0b013e3181958f4b
    1. Carraro U, Boncompagni S, Gobbo V, et al. . Persistent muscle fiber regeneration in long term denervation. past, present, future. Eur J Transl Myol 2015;25:4832. 10.4081/bam.2015.2.77
    1. Carlson BM. The biology of long-term denervated skeletal muscle. Eur J Transl Myol 2014;24:3293. 10.4081/bam.2014.1.5
    1. Chou R, Hashimoto R, Friedly J, et al. . Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med 2015;163:373–81. 10.7326/M15-0934
    1. Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophys 2007;43:79–89.
    1. Hill J, Lewis M, Papageorgiou AC, et al. . Predicting persistent neck pain: a 1-year follow-up of a population cohort. Spine 2004;29:1648–54. 10.1097/01.brs.0000132307.06321.3c
    1. Blozik E, Laptinskaya D, Herrmann-Lingen C, et al. . Depression and anxiety as major determinants of neck pain: a cross-sectional study in general practice. BMC Musculoskelet Disord 2009;10:13. 10.1186/1471-2474-10-13
    1. Turk DC, Dworkin RH, Allen RR, et al. . Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 2003;106:337–45. 10.1016/j.pain.2003.08.001
    1. Chung SG. Convulsion caused by a lidocaine test in cervical transforaminal epidural steroid injection. PM R 2011;3:674–7. 10.1016/j.pmrj.2011.02.005
    1. Cohen SP, Larkin TM, Chang AS, et al. . The causes of false-positive medial branch (facet joint) blocks in soldiers and retirees. Mil Med 2004;169:781–6. 10.7205/MILMED.169.10.781
    1. Brinks A, Koes BW, Volkers ACW, et al. . Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 2010;11:206. 10.1186/1471-2474-11-206
    1. Cohen SP, Bicket MC, Jamison D, et al. . Epidural steroids. Reg Anesth Pain Med 2013;38:175–200. 10.1097/AAP.0b013e31828ea086
    1. Carragee EJ, Hurwitz EL, Cheng I, et al. . Treatment of neck pain. Spine 2008;33:S153–69. 10.1097/BRS.0b013e31816445ea
    1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA 2016;315:1624–45. 10.1001/jama.2016.1464
    1. Lundh A, Gøtzsche PC. Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies. BMC Med Res Methodol 2008;8:22. 10.1186/1471-2288-8-22
    1. Bicket MC, Hurley RW, Moon JY, et al. . The development and validation of a quality assessment and rating of technique for injections of the spine (AQUARIUS). Reg Anesth Pain Med 2016;41:80–5. 10.1097/AAP.0000000000000337
    1. Geurts JW, van Wijk RM, Stolker RJ, et al. . Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Reg Anesth Pain Med 2001;26:394–400. 10.1053/rapm.2001.23673
    1. Masic I, Miokovic M, Muhamedagic B. Evidence based medicine - new approaches and challenges. Acta Inform Med 2008;16:219–25. 10.5455/aim.2008.16.219-225
    1. Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Med J Aust 1988;148:233–6. 10.5694/j.1326-5377.1988.tb99431.x
    1. Perez-Roman RJ, Brusko GD, Burks SS, et al. . Use of single-photon emission computed tomography imaging for hypermetabolic facet identification in diagnosis of cervical and axial back pain. World Neurosurg 2020;137:e487–92. 10.1016/j.wneu.2020.02.016
    1. Manchikanti L, Damron K, Cash K, et al. . Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial NCT0033272. Pain Physician 2006;9:333–46.
    1. Manchukonda R, Manchikanti KN, Cash KA, et al. . Facet joint pain in chronic spinal pain: an evaluation of prevalence and false-positive rate of diagnostic blocks. J Spinal Disord Tech 2007;20:539–45. 10.1097/BSD.0b013e3180577812
    1. Hahn T, Halatsch M-E, Wirtz C, et al. . Response to cervical medial branch blocks in patients with cervicogenic vertigo. Pain Physician 2018;21:285–94.
    1. Manchikanti L, Singh V, Pampati V, et al. . Is there correlation of facet joint pain in lumbar and cervical spine? An evaluation of prevalence in combined chronic low back and neck pain. Pain Physician 2002;5:365–71.
    1. Manchikanti L, Boswell MV, Singh V, et al. . Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord 2004;5:15. 10.1186/1471-2474-5-15
    1. Yin W, Bogduk N. The nature of neck pain in a private pain clinic in the United States. Pain Med 2008;9:196–203. 10.1111/j.1526-4637.2007.00369.x

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться