Effectiveness of Cervical Medial Branch Blocks in Chronic
Neck Pain: A Prospective Outcome Study

Manchikanti, Laxmaiah; Kn, Manchikanti; Ks, Damron; Pampati,

doi:10.36076/ppj.2004/7/195

Cited by 49 publications

(5 citation statements)

References 32 publications

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“…Overall, the results show that radiofrequency neurotomy is effective in 54–76% with multiple passes providing multiple lesions taking several hours to perform a single lesion, whereas cervical facet joint nerve blocks with easy performance except that the relief is half that of radiofrequency neurotomy in duration with success rate ranging from 85% to 92% at 12-month follow-up, showing level II evidence with moderate strength of recommendation by the American Society of Interventional Pain Physicians (ASIPP) guidelines utilizing one RCT [ 30 ] and three observational studies [ 89 – 91 ].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

et al. 2022

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Background Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks. Study Design Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis. Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain. Methods Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined. Results Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is level II in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was level III to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions. Limitations There was a paucity of literature and heterogeneity among the available studies. Conclusion This systematic review and meta-analysis shows level II evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with level III to IV evidence in managing cervicogenic headaches. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-022-00455-0.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

et al. 2022

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“…Major complications were reported to be extremely rare in all the review articles assessed 22,46,48,49) .…”

Section: Management Of Whiplash Using Targeted Injectionsmentioning

confidence: 97%

“…CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/). controlled trial that reported up to 85% improvement in functional and pain scores at 2 year followup [47][48][49] . The findings of a systematic review by Boswell et al were more equivocal 33) .…”

Section: Management Of Whiplash Using Targeted Injectionsmentioning

confidence: 99%

A Review of the Clinical Utility of Therapeutic Facet Joint Injections in Whiplash Associated Cervical Spinal Pain

Eseonu

Panchmatia

Pang

et al. 2022

Spine Surg Relat Res

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Background and Objective Whiplash neck injury was described by Crowe in 1928. Whiplash-associated disorder (WAD) is defined as a cervical spinal injury following an acceleration-deceleration mechanism. It is a constellation of symptoms due to psychological factors and neural adaptations, with significant social costs. Review Summary There are multiple classification systems for WAD in the literature. The Quebec Classification is most reported and is predictive of the likelihood of progression to chronicity. The facet joint has been identified as a pain generator in 50% of cases. We outline the likely anatomical cause of WAD and summarize the protocol of medial branch block injections for diagnostic and therapeutic purposes, as well as the indications for and published results of facet joint ablation in WAD. We also highlight the development of ultrasound as an alternative to computed tomography or fluoroscopy for injection guidance. Conclusions WAD is a complex condition associated with sensory disturbance, pain, motor chronic pain, and psychological distress. The literature supports a single diagnostic medial branch block followed by a therapeutic facet joint ablation for chronic pain. WAD should be managed in a multidisciplinary fashion, with an early involvement of psychological specialists when required.

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“…The cervical facet is an important structure involved in spinal movement, and its fracture or injury often causes loss of spinal stability and spinal nerve injury, which is an important cause of cervical diseases. [1][2][3] However, due to the complex anatomical structure of the lower cervical spine, treatment can be challenging. Most conventional computed tomography (CT) examinations can detect cervical facet injuries or fractures at an early stage, but conventional images are obtained with low-resolution imaging methods and the detection level is insufficient for microstructural analysis.…”

Section: Introductionmentioning

confidence: 99%

Examination of the microstructures of the lower cervical facet based on micro-computed tomography: A cadaver study

Jun

et al. 2022

Medicine

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The cervical facet has complicated 3D microstructures and inhomogeneities. The cervical facet joint, which also participates in the formation, plays a certain role in regulating and limiting the movement of the spine. Correct identification and evaluation of its microstructure can help in the diagnosis of orthopedic disease and predict early phases of fracture risk. To evaluate the safety of the cervical spine by measuring and analyzing the microstructures and morphometric parameters of bone trabeculae in the normal cervical facet with high-resolution 3D micro-computed tomography. Thirty-one sets of C3 to C7 lower cervical vertebrae (155 vertebrae) were scanned using micro-computed tomography. The morphological characteristics and direction of trabecular bone in the facet of the lower cervical vertebrae were observed by selecting and rebuilding the areas of interest, and the changes in the microstructure of the areas of interest were calculated to reveal the structural characteristics and weak areas. Images indicated an ossified center between the superior and inferior articular processes of the lower cervical spine. The cellular bone trabeculae of the articular process had complex reticular microstructures. The trabecular bone plate near the cortical bone was lamellar and relatively dense, and it extended around and transformed into a network structure, and then into the rod-shaped trabecular bone. The rod-shaped trabeculae converged with the plate-shaped trabeculae with only 1 to 2 layers surrounding the trabeculae cavity. Statistical results of the morphological parameters of the trabecular bone showed that trabecular bone volume fraction values were significantly higher for C7 than for C3 to C6 (P < .05). There were significant differences between C7 and C3 to C5 and between C6 and C4 in bone surface area/bone volume (P < .05). There was a significant difference between C7 and C3 to C6 in trabecular bone thickness values (P < .05). The degree of anisotropy value was significantly smaller for C3 than for C6 and C7 (P < .05). The changes in the C3 to C7 microstructure were summarized in this study. The loading capacity and stress of the C7 articular process tended to be limited, and the risk of injury tended to be higher for the C7 articular process.

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Effectiveness of Cervical Medial Branch Blocks in Chronic Neck Pain: A Prospective Outcome Study

Cited by 49 publications

References 32 publications

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain

A Review of the Clinical Utility of Therapeutic Facet Joint Injections in Whiplash Associated Cervical Spinal Pain

Examination of the microstructures of the lower cervical facet based on micro-computed tomography: A cadaver study

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