Fusion for Occult Posttraumatic Cervical Facet Injury

Abstract

Persisting neck pain and headache is a common complication of acceleration/deceleration injury. Seventy patients with normal imaging studies and persisting pain after injury (median 1.7 y), who had failed all usual conservative forms of care were offered a diagnostic block protocol to determine the origins of the persisting pain. Blocks included C-2-3 roots bilaterally; C-2-3-4 zygapophyseal joints, and provocative discography at C-3-4, 4-5, 5-6, 6-7. Seventy patients entered the study; 67 completed the block protocol. On the basis of response to blocks, 44 patient were chosen for posterior cervical fusion of C-l, 2, 3, 4 in several combinations. Seventynine percent of patients achieved complete pain relief; 14% received satisfactory pain relief; fusion was achieved in 95%. These data support the hypothesis of Bogduk and associates that upper cervical facet injury is a common consequence of acceleration/deceleration accidents. The symptoms can be relieved by upper cervical fusion in some patients selected by concordant blocks.

Evaluating Chronic Pain Patients Using Methods from Johns Hopkins Hospital Physicians

“…The Treatment Algorithm recommends the standard anatomical tests, but then progresses to recommend the physiological tests used to diagnosis patients at Johns Hopkins Hospital. These tests allowed Dr. Long and his colleagues to better diagnosis 70 patients who had been told by their previous physicians that nothing could be done to help their headache and neck pain (34). This research, as well as earlier research by Hendler et al, on 180 patients, led to surgery in 50% to 63% of patients who had been previously told that there was no further treatment for their problems with chronic pain [6,7,34].…”

“…When the group utilized provocative discograms, facet blocks, and root blocks, they found that 44 of the patients (63%) were candidates for surgery. After surgery was performed, 93% of the patients reported improvement [34].…”

“…Researchers from Johns Hopkins Hospital have published articles demonstrating that 40% to 80% of chronic pain patients are misdiagnosed [6][7][8][9][10]. For special diagnoses, erroneous diagnoses may reach levels of 92% to 97% for victims of electrical shock, or those mistakenly called fibromyalgia [11,12].…”

Why Chronic Pain Patients are Misdiagnosed 40 to 80% of the Time?

“…After surgery was performed, 93% of the patients reported improvement. 33 The hallmark of a good evaluation for chronic pain is taking a careful and thorough history. This requires information about the location of the pain, in intimate detail.…”

“…A number of researchers from Johns Hopkins Hospital have published articles demonstrating that 40 to 80% of chronic pain patients are misdiagnosed. [6][7][8][9][10] For special diagnoses, these overlooked or erroneous diagnoses may reach levels of 92 to 97% for victims of electrical shock, or those mistakenly called fibromyalgia. 11,12 There are two major factors causing misdiagnosis.…”