Treatment of Chronic Cervical Zygapophyseal-Joint Pain

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Abstract
With regard to the article by Lord et al. on percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain (Dec. 5 issue),1 one of the principles of treatment after musculoskeletal injury is to protect the injured area and prevent the patient from assuming postures and performing movements that continue to aggravate the injury. This may be especially difficult with a neck injury. Much of the pain experienced by the subjects in this study before the surgery probably served no useful purpose and caused unnecessary suffering. Yet some of the pain may have warned or prompted them to avoid certain postures and activities: to turn the torso rather than the neck or to extend the thoracic spine and flex the neck at the occiput to avoid impingement of facet joints. The neurotomy procedure creates the substrate for Charcot's joint in patients with a mean age of 43 years and a life expectancy of more than 30 years. Comparison of patients treated with neurotomy with controls 5 to 10 years after the procedure would be important. Will neurotomy eventually lead to an anesthetic, unprotected, degenerative joint?

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