Cervical Facet Arthritis Study
BACKGROUND: Neck pain is a common complaint among individuals age 50 and over. Among those 50 and over with chronic neck pain and restriction of range of motion, up to 40-50% suffer from osteoarthritis of the facet joints. Current treatments include corticosteroid injection and the delivery of biologic agents, such as platelet-rich plasma or bone marrow aspirate concentrate containing stem cells.
Prior to the refinement of ultrasound-guided delivery methods, many the facet joints could only be injected using fluoroscopic (x-ray) guidance. The disadvantages of x-ray include: 1) radiation exposure, 2) a 2-dimensional approach that often necessitates painful contact with the bone, and 3) use of a contrast agent to ensure needle placement which reduces the space available for the therapeutic medication, possibly neutralizes the effectiveness of biologic agents, and risks allergic reaction. Difficult to perform and time consuming, the fluoroscopic technique may be less than 80% accurate.
When unsuccessful, many patients are driven toward a significantly more costly and invasive procedure: radiofrequency ablation of the medial branch nerves using microwaves. These nerves contribute to rotation and angulation of the head and neck. Ablating these nerves in the lumbar spine has been shown to accelerate disc degeneration and could do the same in the cervical spine.
HYPOTHESIS: Using our ultrasound-guided technique, full doses of biologic agents can be delivered with greater accuracy directly to the affected area without harm of radiation.
CURRENT RESEARCH FINDINGS: We have succeeded in our goal of developing a technique using ultrasound & fluoroscopy. As of August 2017, we have done intradiscal PRP on 201 patients, 482 discs and total of 244 procedures including the cervical, thoracic and lumbar.
GOAL: Dr. Bodor and Yvette Uribe have begun preparing their findings for submission to either the Journal of Ultrasound Medicine, Spine, or Physical Medicine & Rehabilitation Journal. Dr. Naven Murthy of the Mayo Clinic will co-author.