Pain Physician, Volume 5, Number 4, pp 365-371 2002, American Society of Interventional Pain Physicians ® ISSN 1533-3159 Original Contribution 365 Is There Correlation of Facet Joint Pain in Lumbar and Cervical Spine? An Evaluation of Prevalence in Combined Chronic Low Back and Neck Pain Laxmaiah Manchikanti, MD*, Vijay Singh, MD**, Vidyasagar Pampati, MSc # , Kim S. Damron, RN ## , Carla D. Beyer, RN ## and Renee C. Barnhill, RN ## From Pain Management Center of Paducah, Paducah, Kentucky and Pain Diagnostics Associates, Niagara, Wis- consin. *Dr. Manchikanti is the medical director at Pain Management Center of Paducah, **Dr. Singh is the medi- cal director at the Pain Diagnostics Associates, # Mr. Pampati is the statistician and ## Ms. Damron, Ms. Beyer and Ms. Barnhill are clinical coordinators at Pain Man- agement Center of Paducah. Address correspondence: Laxmaiah Manchikanti, MD, 2831 Lone Oak Road, Paducah, KY 42001. E-mail: drm@apex.net Funding: No financial support was obtained for this study. Among the chronic pain problems, pain emanating from cervical and lumbar regions, independently or in combination, constitutes a significant and frequently encountered problem in interventional pain management practices. This study was designed to test the assumption that patients presenting with chronic low back pain of lumbar facet joint origin may also present with chronic neck pain of facet joint origin. Considering that many studies show the prevalence of facet joint involvement in chronic low back pain as ranging from 15% to 45% compared to prevalence of involvement of cervical facets in chronic neck pain, ranging from 54% to 60%, we sought to evaluate the correlation between lumbar facet joint to cervical facet joint pain. One hundred twenty consecutive patients with chronic neck and low back pain were evaluated utilizing controlled diagnostic blocks with lidocaine and bupivacaine. The results showed prevalence of cervical facet joint pain in 67% of the patients with a false-positive rate of 63% with a single block, whereas the prevalence of lumbar facet joint pain was seen in 40% of the patients with a 30% false- positive rate with a single block in patients presenting with chronic low back and neck pain. There was also significant correlation noted with 94% of the patients with confirmed lumbar facet joint pain also presenting with cervical facet joint pain. Keywords: Chronic low back pain, chronic neck pain, lumbar facet joints, cervical facet joints, zygapophysial joints, controlled diagnostic blocks, false-positive rate, prevalence The zygapophysial or facet joints are paired diarthrodial articulations between posterior elements of the adjacent vertebrae (1-3). These joints are formed by the articulation of the inferior articular processes of one vertebra with the superior articular processes of the next vertebrae. It has been assumed that degeneration of the disc and facet joints would lead to low back pain and neck pain. These assumptions were based on the pathogenesis of degenerative cascade in the context of three joint complex that involves the articulation between two vertebrae consisting of the intervertebral disc and adjacent facet joints, as changes within each member of this joint complex will result in changes in others in lumbar and cervical spine (4-9). The prevalence of disc degeneration, spondylosis and facet joint osteoarthritis increase with increasing age (10). Sambrook et al (11) showed simultaneous disc degeneration in cervical and lumbar spine. Similarly, spondylosis is also common in cervical and lumbar spine. Spondylosis is often used to describe vertebral osteophytosis secondary to degenerative disc disease or osteophytosis of the facet joints. But, spondylosis only accurately describes vertebral osteophytosis secondary to degenerative disc disease. Osteophytes occurring at the facet joints are different from osteophytes occurring on the vertebral margins adjacent to the disc. However, radiographic changes of osteoarthritis have been shown to be equally common in patients with and without low back pain and degenerative joints seen on computed tomography (CT) are not always painful, even though some studies report severely degenerated joints as being more likely to be symptomatic.