الفهرس 
CERVICAL FACET JOINT AND ITS DYSFUNCTION
SONOANATOMY OF CERVICAL MEDIAL BRANCHOnly 14 pages are availabe for public view
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Abstract
The cervical facet joints are a major cause of chronic neck pain, being the fourth most common cause for years lived with disability in the world. Also being the primary source of pain in 26–70% of patients with chronic neck pain. Cervical facet joints are diarthrodial joints formed by the superior articular process of one cervical vertebra that articulates with the inferior articular process of the vertebrae above at the level of the junction of the lamina and the pedicle. he cervical facet joints are innervated by the medial branches of the dorsal rami. The fibrous joint capsule is richly innervated with mechanoreceptors, as well as nociceptors. Inadequate information about variation of vertebral artery can expose the VA to the risk of injury resulting in grave consequences, especially if the dominant artery is involved in asymmetry. The classic clinical presentation of an individual suffering from cervical facet mediated pain is generally unilateral neck pain, as well as pain on cervical rotation and extension. In some cases, pain radiation is segmental and does so in particular patterns, not extending beyond shoulder level. Physical examination of the neck has been found to be highly sensitive but of low specificity in a study in which 77% of subjects were identified as having typically facet joint pain. However, other studies have shown that certain physical examination maneuvers can identify the cervical facet joint as the primary cause of neck pain. In daily clinical practice, history taking and physical examination help rule out serious pathological conditions and yield an actionable diagnosis. Cervical facet joint pain is generally treated conservatively without intervention at first. However, there are currently no studies specifically evaluating the role of conservative measures in the management of established cervical facet joint pain. Once conservative management fails, with persistent pain and disability, patients may be considered for an interventional therapeutic procedure, once the diagnosis is confirmed. The effect of cervical facet intra-articular injection of local anesthetic with a corticosteroid solution has shown conflicting results. Cervical Medial branch block injections are commonly used to diagnose facetogenic pain. Radiofrequency neurotomy is considered the most successful treatment approach for chronic facetogenic pain. If cervical medial branch thermal radiofrequency neurotomy is performed correctly it can provide sustained analgesia, result in complete pain relief lasting up to several years. This prospective randomized study was carried out on thirty patients in Tanta university hospital from July 2021 to July 2022. The patients were included being diagnosed with chronic neck pain of facet origin for three or more months, cervical MRI free, failure of conservative medical treatment as non-steroidal and pregabaline combination and physiotherapy and documented 80% symptom relief with dual concordant medial branch block before cervical medial branch radiofrequency ablation as recommended by the spine interventional society. Our Procedure was conducted in two steps: firstly, performing Cervical Medial Branch Block. Secondly, only patients with ≥ 80% symptom relief with dual MBBs were included for the radiofrequency neurotomy of cervical medial branch. Our results showed significant reduction of pain index, improvement in Neck Disability index score and also improvement of patients’ satisfaction in all times of measurements and follow up. It can be concluded from the present study that the ultrasound guided cervical medial branch radiofrequency ablation is effective and safe technique in treatment of chronic neck pain of zygapophysial joints origin.