Many patients, between ages 30 and 50 years old, suffer from long-term soreness and pain in the neck, numbness in the arms and fingers or stiff neck. Such condition has had impacts on the individuals, family, and workplaces. In general, diseases related to the neck may cause similar soreness and pain locally, even leading to radiated pain to the upper limbs and head.

Diagnosis Neurological Blockade

Patients often go through many examinations to find the causes for this painful condition, including cervical X-ray, Magnetic Resonance Imaging (MRI), and nerve conduction study.

Statistics showed that 30% of the patients who went through all these examinations still could not find the causes for the pain. This article focused on the functions of diagnostic neurological blockade based on the cervical facet syndrome that often causes pain in the neck.

Nerve root injection, epidural injection and facet medial branch injection are often used for diagnostic neurological blockade treatment for cervical pain.

The Procedures of Diagnostic Neurological Blockade

For the precision of such diagnostic injection, it is best to have this procedure done in an operating room with X-ray device. At CMUH, patients are scheduled at the outpatient department and checked into the operating room. The steps are as follow:

• Patients’ vital signs are carefully monitored. IV injection will be used if sedative anesthesia is required.
• Patients lie on their stomach or on the side. Ultrasound and X-ray will be used to guide the localization of the injection site. After disinfection, local anesthetics is injected into the epidermis.
• Guided by X-ray, a thin long needle is used to reach cervical facet nerve. If a special electric needle is used, the doctor will inject the medicine (local anesthetic) into the cervical facet nerve (medial branch) after locating the spot with electric stimulation.
• Patients may go home 30-60 minutes after the injection.

The Interpretation of Diagnostic Neurological Blockade

To lower the false positive rate of diagnostic neurological blockade, patients are recommended to have twice or more diagnostic neurological blockade, with more than 50% of pain relief each time and the effective period should be in accordance with the effective period of local anesthetic.

Who are Not suitable for Diagnostic Neurological Blockade?

Not all patients with neck pain are suitable for diagnostic neurologic injection. Patients with the following conditions should not go through the procedure:

• Abnormal coagulation: INR > 1.5 or platelet < 50,000/mm3
• Pregnancy, infection in the skin of the injection area, history of severe allergy to drugs
• Had spinal fusion surgery that may cause difficulty in localization, significant abnormal nerve examination results, such as Myasthenia Gravis or abnormal reflexes.

Possible Risks of Diagnostic Neurological Blockade

The possible risks of diagnostic neurological blockade are as follow:

• Pain in the injection area, hemorrhage
• Allergic reactions to local anesthetics, such as dizziness, temporary upper limb weakness and numbness.
• Infection in the spines (very rare)
• Continuous numbness, lower limb motor and peripheral nerve injury (very rare)

Treatments after Diagnosis

• Once patients are diagnosed with cervical facet syndrome through diagnostic neurological blockade, they may receive radiofrequency coagulation for long-term pain relief, which is with a very high success rate and effectiveness.
• Neck pain is a very common symptom and sometimes it is difficult to obtain an accurate diagnosis based only on medical history, physical examination, or radiocontrast. Therefore, it is reasonable to start with more conservative treatments such as short-term anti-inflammatory painkiller, rest or rehabilitation.
• When patients are not able to have satisfactory results from the aforementioned treatments, diagnostic neurological blockade may be conducted to find the possible causes of the pain. Patients will be able to receive a certain degree of pain relief through the diagnostic blockade and even be pain-free after radiofrequency coagulation.