Interruption of pain pathways in the treatment of the cervical syndrome

In the cervical syndrome a distinction should be made between an upper and a lower type. The upper type is usually emanating from the intervertebral or facetal joints, since pathology causing nerve-root irritation is confined to the more caudal segments. In the lower type nerve-root irritation is usually the cause of pain but secondary irritation of the facetal joints can be an important contributing factor. Treatment should primarily be conservative. If this fails and if surgical intervention is not indicated an attempt should be made to interrupt pain pathways. This can be done by division of the posterior primary rami or by making a radio-frequency lesion in the dorsal root ganglion. The results indicate these procedures can be of considerable help in a group of patients who do not respond to any other treatment.