Take it easy friends, don't be haters and don't patronize me for trying to get some opinions. See it as a sign of respect and don't regress to junior high school name calling. You should search for some insight as to why you become so defensive. Certainly not the way a professional physician should communicate.
As for tossing around my credentials, I was asked if I was a resident so needed to clarify.
I wasn't attacking you in my initial post, just clarifying your situation. The reason for that because the way
a professional physician should communicate
involves two things-
1-Proper terminology, L3, L4, L5 MBB(not S1)
2-Phrasing your question in a specific fashion so your audience knows that you understand the core background science, and you're not asking something you should have looked up.
I did my residency at Harvard and my attendings would have ripped me a new one for phrasing a question like that on rounds. Maybe you had nicer attendings during your time in Boston?
Anyway, regarding cervical mbb/rf- I'd say that C5-C6 is the most commonly involved joint for facet pain, but the neck is more complicated that the lumbar spine as cervical facet pain is most common at the most superior and most inferior levels of the neck (in contrast to the lumbar spine where RF is mostly performed at the lower levels)
Because of that variability, it's important to use every tool you have to narrow down cervical MBB/RF to the levels where you can best help your patients.
I find pain patterns to be helpful, but only in conjuction with imaging and palpation. You have to be careful palpating C5-C6 and C6-C7 because it's easy to confuse facet pain with paraspinal pain at the lower cervical levels particularly at C6-C7. I find palpation more reliable at C4-C5 and above. Palpation isn't necessarily useless below that, but I think imaging and pain referral patterns play a larger role diagnosing facet pain at C5-C6 and C6-C7, particularly when you're starting out and your palpation skills are still developing.
If they have headache or upper neck pain, you want to be sure to be in the habit of palpating C2-C3 and C3-C4 as you'll pick up facet pain or TON mediated pain in patients that often have unremarkable upper cervical facets on MR. TON mediated pain is missed all the time by neurologists and spine surgeons.
Finally, all that clinical decision making is for naught unless you perform careful cervical MBB and thorough multi-lesion cervical RF.
It may sound trite, but it's particularly important during your first few years as you build your practice and you'll soon establish a solid mental relationship of MBB/RF results to your initial clinical impression.