The building blocks of the spine are the vertebrae, held together by joint ligaments. Between the vertebrae are the intervertebral discs, which act as shock absorbers within the spine. The muscles are responsible for movement. The integrity of each component is important for proper biomechanics. If one is damaged, the others compensate for a while, but eventually, spinal degeneration begins. Initially, this may occur without symptoms, but sooner or later, complaints arise depending on the stresses the spine has endured.

Cervical spine issues can arise from an accident or a bad movement, but more often, they develop slowly from repeated microtrauma, overuse, or chronic poor posture. It’s common for the neck muscles and shoulder girdle to feel “tired or sore” for years, but patients typically do not seek treatment for that. Meanwhile, the instability continues to increase. The patient may experience myofascial (muscle-origin) pain with sensitive muscle bundles or knots, which is generally not very disturbing and can somewhat decrease with massage and exercise. However, as the spine, as a biomechanical unit, continues to weaken, radicular pain (radiating to the head or arm) or facet (small joint) pain may develop.

Cervical Radicular Pain

The symptoms of cervical radicular pain depend on which nerve root is compressed between the bone and the disc. The C1, C2, C3 roots can cause headaches, while the C4, C5, C6, C7, C8 roots can cause arm pain and weakness in addition to neck complaints. For treating a compressed nerve root, a transforaminal block/selective nerve root block is suitable, which is an ultrasound- or x-ray-guided intervention where a steroid is administered to reduce the swelling of the compressed nerve root. A more complex form of this intervention is epidurolysis, where under x-ray guidance, a thin catheter is placed next to the nerve root, and various medications can be administered over about 5-6 hours. The catheter is then removed. PRP treatment, which reduces microinstability of the cervical spine, is almost always recommended. This improves the biomechanics of the neck, bones-joint ligaments, and thus reduces the work load on the neck muscles, decreasing muscle tension and pain.

Cervical Facet (Small Joint) Pain

Another treatment option is cervical medial branch radiofrequency ablation. This procedure eliminates the innervation of the cervical facet joints (medial branch), reducing the sensation of pain. This intervention is always preceded by a diagnostic injection.