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The lack of reproducibility of the radiological diagnosis of cervical degenerative changes and the existence of subjects with asymptomatic cervical degenerative abnormalities, make the clinical diagnostic value of standard cervical X-rays disputable.[18] Other radiological http://www.selleckchem.com/products/Romidepsin-FK228.html imaging techniques like MRI or CT might be more appropriate in defining degenerative changes of the facet joints, but they are not yet used as a standard work-up for diagnosis in chronic degenerative neck pain.[17, 19, 20] In most studies, patients are selected by single or double diagnostic blocks[7, 21]. A single diagnostic block has a low discriminative value, because most patients show a positive result to a single diagnostic block.[4] Double test blocks could reduce the number of false-positive results.[22, 23] They have, however, the potential risk of an increasing number of false-negative results.[21, 24] Therefore, the use of these double blocks is still under debate.[21, 25]A recent randomized study BML-190 on diagnostic blocks in the lumbar region showed that performing 0 blocks might even be more cost-effective than performing one or two blocks.[26] More studies are needed to compare results of selecting patients for cervical facet pain using 0, 1, or 2 blocks. In this study, patients were not selected based on diagnostic blocks, but rather, based on clinical signs and symptoms. In the cervical facet joint pain syndrome, the pain frequently follows fixed irradiation patterns, depending on which cervical facet joint is involved.[27] On clinical examination, such patients often show paravertebral tenderness on manual segmental pressure over the cervical facet column. We used the radiation pattern of the pain and the localization of the maximal pain on manual pressure to define the treatment level. A flaw of this method is that manual segmental examination of the cervical spine is a nonvalidated method. In our posterior-lateral RF treatment technique, first described BMS-907351 research buy by Sluijter, the needle endpoint is in close proximity to the origin of the dorsal ramus (Figure?1). The advantage of this location is that there is less interindividual anatomical variation in the dorsal ramus being close to the segmental nerve.[8] At this point, the distance between the dorsal ramus and the superior articular process varies by