Diagnostic and therapeutic injections for the nonoperative treatment of axial neck pain and cervical radiculopathy

Neck pain with or without cervicogenic headache consumes an enormous amount of medical services, and yet no clinical studies have addressed the validity of diagnostic or epidemiologic factors associated with muscle lesions, disc pathology, and zygapophyseal joints as pain generators. Provocative cervical discography, when performed by an experienced operator, offers a way to determine which discs are pain generators. This can also provide valuable information in assessing the disc levels above and below a planned discectomy and fusion. Cervical epidural steroid injections have been shown to save anywhere from 40 to 700% of patients from having surgery. Selective cervical steroid injections using a transforaminal approach are being used now by many practitioners for patients with radicular symptoms because they might offer a more specific and targeted treatment modality. The zygapophyseal joint may be an important source of local and referred cervical spine pain. Targeted diagnostic injections with a local anesthetic followed by radiofrequency neurolysis can play an important role in the management of cervical pain. In a promising pilot study, Botulinum toxin injections were found to be effective in identifying cases of chronic whiplash associated with predominantly myogenous etiology.