Painful C1-C2 Facet Arthropathy

Blog Post by H. Gordon Deen, Mayo Clinic, Jacksonville, USA

An often overlooked cause of neck pain is C1 – C2 facet arthropathy.  Patients with this disorder present with severe upper cervical pain which is invariably unilateral on the side of the abnormal facet joint.  Pain is consistently reproduced by cervical extension and by looking over the shoulder on the affected side.

For a variety of reasons, the diagnosis is often missed on MRI.  First, axial MR images are in essentially the same plane as the abnormal facet joint and the cuts may fall immediately above and below the joint, thereby missing the abnormality.  Second, coronal imaging, which is the best way to visualize the upper cervical facet joints, is not routinely done with MR studies of the cervical spine.  And third, bony detail is not seen as well on MR as it is on CT scanning.  Thus, it is not unusual for a patient to undergo several MRI studies without establishing the diagnosis.

High resolution CT with coronal cuts provides superb visualization of the C1-C2 facet joints and should be performed whenever this diagnosis is suspected.  If CT scanning shows a degenerated facet joint on the side of the pain, it is often helpful to confirm the joint as the pain generator by performing a diagnostic anesthetic C1-C2 facet injection.

If the pain is abolished with a diagnostic injection of the facet joint, C1 – C2 fusion often provides excellent long-term pain relief. 

For more information, please see Spine Disorders: Medical and Surgical Management, by J.D. Bartleson and H. Gordon Deen, published by Cambridge University Press.