Cervical medial branches

The cervical facet joints are a relatively common cause of axial neck pain worldwide. These joints are paired diarthrodial joints that connect the respective superior and inferior vertebrae of the cervical spine. Facet joints are innervated by the respective medial branches of the dorsal primary rami of the corresponding exiting spinal nerves. Facetogenic cervical pain typically presents as axial neck pain without radiation to the upper extremities. The pain can be referred to the occipital area in the superior levels or the shoulders in the inferior levels. Physical examination may show worsening pain with cervical extension or rotation, as well as tenderness to palpation along the facet joint line. However, physical exams are not very specific or diagnostic. In order to confirm the diagnosis, a cervical medial branch block (MBB) can be performed. A cervical MBB with local anesthetic can be diagnostic as it can confirm the etiology of the pain as facetogenic. Following confirmation of the diagnosis with dual MBB providing significant pain relief, radiofrequency ablation (RFA) of these nerves can be done, providing pain relief for as long as 6 to 12 months. It is imperative to educate the patient on the diagnostic nature of medial branch blocks. Given that local anesthetics have a relatively short half-life, the effect of a medial branch block may only be temporary. The following chapter describes the most commonly performed techniques for cervical medial branch blocks and radiofrequency ablation.