Surgical Treatment for Zygapophysial Joint Pain After Whiplash
This study is the latest update from the Cervical Spine Research Unit of Australia on the role of cervical zygapophysial joint pain as a result of whiplash injuries. According to the authors, "In about half of patients with chronic neck pain of this type, the pain originates in the cervical zygapophysial joints. It cannot be diagnosed clinically or radiographically but can be identified by using local anesthesia to block the nerves supplying the painful joint. However, treatment has remained problematic."
In this current study, the researchers examined the effectiveness of percutaneous radio-frequency neurotomy in treating painful cervical zygapophysial joints in patients who had pain an average of 34 months. This procedure involves burning the nerves supplying the joint capsule with an electrode at 80° C (176° F). Twelve patients received the real treatment, while another matched group of 12 patients received placebo surgery in which the electrode was not heated.
At 27 weeks after the surgery, 7 active treatment patients and 1 placebo patient were pain free. The procedure, however, is not a permanent treatment for zygapophysial joint pain. "Although we have shown that percutaneous radio-frequency neurotomy is significantly more efficacious than placebo, problems with the procedure remain. Despite apparently clear diagnoses, patients may obtain no relief even after more than one neurotomy. Others can have additional pain revealed after their original, dominant pain is treated."
At best, the authors state that pain relief can last for "months to over a year," but the long-term odds of success for the treatment is only 40%. Furthermore, the procedure exposes the patient to harm from infection, radiation, and postoperative pain.
Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophysial joint pain. New England Journal of Medicine 1996;335(23):1721-1726.
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