Short summary

Cervical disc herniation and degenerative disease often results in nerve root compression leading to radicular pain. This can be relieved by surgical decompression of the nerve root. Prior to this, the use of selective facet joint block (SFJB) can help determine the symptomatic nerve root. The purpose of this study is to gain knowledge about the effect of the blockades. If it turns out that a number of patients have a prolonged effect of the blockade, this can potentially be used therapeutically

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Rationale

Cervical disc herniation and cervical degenerative disease often results in nerve root compression leading to debilitating radicular pain. This pain can be relieved by surgical decompression of the compressed nerve root. Usually, the level of nerve root compression is obvious from clinical signs and corresponding radiology - most often magnetic resonance imaging (MRI). However, degenerative disease is often disseminated to multiple cervical levels. Also, the level of nerve root compression cannot always be determined from clinical examination. Furthermore, radicular pain can be difficult to distinguish from facet-joint and myofascial pain with diffuse distribution to shoulder and upper arm.

Under these circumstances, the use of selective facet joint block (SFJB) can be useful to determine the symptomatic nerve root. Data suggest that the effect may be long lasting (i.e. > 2 weeks) in some patients1. In addition, the block may relieve not only nerve root pain but also neck pain. Finally, the proportion of patients who experience pain relief after facet-joint block who also experience pain relief from decompressive surgery is currently unknown.

The objective of the present study is to evaluate

1) The effect and duration of SFJB on cervical radicular pain.

2) The effect and duration of SFJB on neck pain.

3) The effect of surgery on radicular pain after positive SFJB.

4) The effect of surgery on neck pain after positive SFJB (on neck pain).

Secondary objective is to identify (if possible) factors that predispose to long lasting effect (> 3 months).

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Description of the cohort

Patients with cervical disc herniation and cervical degenerative disease, and age > 18 can be included. Informed consent will be obtained. Exclusion criteria are pregnancy and previous cervical spine surgery. Patients will be included by one of three neurosurgeons at the outpatient clinic. The decision to refer to surgery and/or SFJB is on the discretion of the neurosurgeon. Reason for SFJB is divided into 4 categories: inconsistency between pain distribution and MRI findings, potential multiple roots involved in pain-generation, uncertainty whether pain is generated from the spine/muscles or nerve root compression, and others. SFJB will be performed by one of two anesthesiologist, guided by fluoroscopy.

Data and biological material

Data will be collected at baseline and follow-ups.

Data will include pain and disability questionaries, demographic data, diagnosis, comorbidities, medications, neurological status. Pain and associated disability are evaluated by: Visual analogue score for neck and arm pain separately, Neck Pain Disability Index Questionnaire (NDPIQ) and EuroQoL (EQ5D). Other data will be collected from the current patient journal system at Mølholm Privathospital.

No biological material will be collected.

Collaborating researchers and departments

RygCenter Mølholm, Privathospitalet Mølholm