PM & R : the journal of injury, function, and rehabilitation
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Review
Update on the role of z-joint injection and radiofrequency neurotomy for cervicogenic headache.
Cervicogenic headache is a common secondary headache that typically is referred from the upper cervical spine, that is, segments C3-C4 and rostral. Diagnostic injections to one or more of these segmental joints (including the atlanto-occipital joint, atlanto-axial joint, and C2-C3 and C3-C4 zygapophysial joints [z-joints]) frequently are used to establish the pain generator in the cervical spine that is responsible for the radiation of pain into the head. ⋯ RF neurotomy may provide the most sustained relief of headache symptoms although the relief typically is not permanent. Pulsed RF, a nondestructive modality, may also have benefit for cervicogenic headaches.
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To determine the frequency of facet joint (FJ) bone marrow lesions, high FJ periarticular signal intensity, and FJ effusions in a convenience sample of patients with axial low back pain (LBP). ⋯ FJ bone marrow lesions, effusions, and high periarticular signal intensity were common in this sample of patients with axial LBP and substantially more frequent than in prior reports from unselected samples of patients with or without radicular pain. These FJ features demonstrate side-specific associations with LBP. Further study of associations between these FJ features and LBP are warranted.