On the nature of neck pain, discography and cervical zygapophysial joint blocks

To determine the prevalence of disc pain and zygapophysial joint pain occurring simultaneously in the same segment of the neck, 56 patients with post-traumatic neck pain underwent both provocation discography and cervical zygapophysial joint blocks. Both a symptomatic disc and a symptomatic zygapophysial joint were identified in the same segment in 41% of the patients. Discs alone were symptomatic in only 20% of the sample. Zygapophysial joints were symptomatic but discs asymptomatic in 23%. Only 17% of the patients had neither a symptomatic disc nor a symptomatic zygapophysial joint at the segments studied. These observations indicate that the investigation of neck pain by discography alone or by zygapophysial blocks alone constitutes an inadequate approach to neck pain which fails to identify the majority of patients whose symptoms stem from multiple elements in the 3-joint complexes of the neck.