• Maarten van Eerd, Jacob Patijn, Daan Loeffen, van KleefMaartenMDepartment of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands., and Joachim Wildberger.
• Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands.
• Pain Pract. 2021 Sep 1; 21 (7): 766-777.

BackgroundIn interventional pain medicine, cervical facet joint (CFJ) pain is commonly treated with CFJ denervation techniques, almost automatically assuming degeneration of the CFJs as an important cause of CFJ pain. A standard cervical X-ray is still commonly used in the clinical evaluation of patients suspected for CFJ degeneration. Although degenerative features can be visualized by different radiological imaging techniques, the relation between radiological degenerative features of the cervical spine and pain remains controversial. Paramount in order to estimate the clinical usefulness of a radiological imaging is to establish the reproducibility of the radiological scoring system. A reproducible and clinically feasible diagnostic scoring system was developed to estimate cervical degeneration on standard cervical X-rays.Materials And MethodsA reproducibility study for the interpretation of degenerative abnormalities on standard cervical X-rays was performed, using a dichotomous outcome (degenerative abnormalities present Yes/No). The estimation of intervertebral disc height loss on standard cervical X-rays was validated with computed tomography (CT) scan measurements.ResultsFive radiological degenerative features on standard cervical X-rays (disc height loss, anterior vertebral osteophytes, posterior vertebral osteophytes, vertebral end plate sclerosis, and uncovertebral osteoarthritis) showed a substantial to excellent reproducibility (kappa value ≥ 0.60). The qualitative definition of disc height loss used in the reproducibility study showed a substantial agreement with the actual measurements of disc height loss on CT scan (kappa value = 0.69).ConclusionSubjective judgment of a cervical standard X-ray is a reproducible method to demonstrate degenerative abnormalities of the cervical spine.© 2021 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.

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