It can sound very frightening when the doctor tells you that you have "cervical facet joint dysfunction (CFJD)." Usually a person grows tired of his/her neck hurting and visits the doctor for a prescription for the neck pain. It’s seldom that simple, but some treatments have been effective for those diagnosed with CFJD.

The neck (cervical spine) consists of seven bones (vertebrae) stacked on each other. They’re named for their position, with C1 at the top and C7 (the one you feel "sticking out") at the base of the neck. The part that you feel "sticking out" is the spinous process to which muscles are attached.

Each vertebra in the entire back has its own spinous process. On either side of the process are bone projections facing down on the bottom and up on the top. These projections connect each vertebra to the one above it and the one below it; the space in between is the facet joint. The joint connection is cushioned by cartilage and surrounded by connective tissue. A fluid produced by the body (synovial fluid) lubricates the joints. The facet joints allow our spines to rotate and to move forward, backward, and from side-to-side. CFJD describes neck pain that comes from injury (e.g., whiplash), wear-and-tear arthritis, or herniated disks (the gel-like cushions between each body of the vertebrae). The subsequent damage to the facet joints causes impingement on nerves (pinched nerve). 

Is there effective treatment for this painful condition? A very recent review of medical literature sought to answer this question. First, it was concluded that this diagnosis is difficult to make. The initial work-up usually includes a physical exam, X-rays, MRIs, CT scans or SPECT (single photon-emission CT). This is done mostly to rule out fractures, herniated disks, spinal cord problems, or lesions/tumors. Once these are ruled out, the nerves that would be affected by CFJD are injected with a numbing agent. Relief of pain helps to verify the diagnosis.

The most effective treatment seems to be radio-frequency (RF) neurotomy: the "pinched nerves" are disabled so that they don't send pain signals to the brain. Past treatment destroyed the nerves; however, this could result in paralysis or loss of muscle function. RF "stuns" the nerve for a period of time, breaking the pain cycle and allowing the body to heal the affected joints.

This can provide permanent relief or relief that lasts up to several months. The authors caution that they found no studies that analyzed using conservative treatment (medications, PT, spinal manipulation or mobilization, other modalities such as heat or ice, etc.) versus joint and nerve injections, surgery, or RF neurotomy. Although there is evidence that 25-66 percent of neck pain is from CFJD, there is limited evidence of what treatment is most beneficial. 

For further information, refer to: "Cervical Facet Joint Dysfunction: A Review," Kirpalani, D MD; Mitra, R MD; Archives of Physical Medicine and Rehabilitation, April 2008, Volume 89(4).