Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

Abstract

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.

Post-operative neurological improvement is associated with significant neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament: a prospective multicenter registry study

“…Discogenic and/or facet genic neck pain, which is caused by degenerated intervertebral disks and facet joints accompanied with segmental instability, can be another possible source of neck pain [15][16] [17]. Fusion surgery can be indicated for discogenic/facet genic neck pain because this category of pain can theoretically be attenuated by fusion of the pain-generating segment [16].…”

Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament

“…Discogenic and/or facet genic neck pain, which is caused by degenerated intervertebral disks and facet joints accompanied with segmental instability, can be another possible source of neck pain 16 – 18 . Fusion surgery can be indicated for discogenic/facet genic neck pain because this category of pain can theoretically be attenuated by fusion of the pain-generating segment 19 .…”

The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue

“…To address the research aim, a standardized screening key was defined to identify a C2 pain pattern 26,[48][49][50] (Figure 2). An identified C2 pain pattern meant that both criteria A and B were met.…”