Axial neck pain without much radicular shoulder arm pain is a somewhat
tricky situation for spine care providers. Patients often have the early-stage
degenerative disease of the cervical intervertebral disc and facet joints, with minimal
spinal alignment changes and without instability. Yet such patients may have legitimate
symptoms and may have failed multiple rounds of physical therapy, spinal injections,
activity modifications, non-steroidal anti-inflammatories, and other medical and
supportive care measures. These patients may not fit traditional image-based spinal
care protocols and are mostly left untreated. This chapter presents the authors'
indications, and clinical outcomes with an endoscopically visualized combined
mechanical and radiofrequency facet ablation with a minimal laminotomy at the
symptomatic levels. They offer their rationale behind their strategies to attend to these
patients with minimal cervical spine disease on advanced images but with
unmanageable complaints who ordinarily have been falling into this watershed area of traditional spine care and reviewing possible pain relief mechanisms. The latter may be
achieved not only by the combined mechanical and radiofrequency ablation of the
cervical facet joint complex but also rely on modulation of the activity of the dorsal
root ganglion of the cervical nerve root at the affected level. Outcomes are favorable in
most patients, suggesting the authors' approach to treating these patients has merits;
thus, warranting further clinical validation.
Keywords: Axial neck pain, Cervical spine, Decompression, Degeneration, Disc
herniation, Endoscopic, Impingement, Minimally invasive, Open,
Radiofrequency, Rhizotomy, Stenosis.
