Studies evaluating the association between imaging pathology and facet joint block and treatment outcomes
| Study | Design | Number of subjects | Results | Comments |
| Holder et al 63 | Prospective study designed to evaluate the sensitivity and specificity of PS or SPECT scans in identifying patients responsive to IA facet injections | 43 patients (male=17, female 26) Mean age 55 years (range 16–18 years) | PS group: sensitivity=0.71, specificity=0.76, (+) predictive value=0.38, (−) predictive value=0.93 SPECT group: sensitivity=1.0, specificity=0.71, (+) predictive value=0.41, (−) predictive value=1.0 | The authors concluded that the high sensitivity and (−) predictive value made SPECT scan a valuable screening tool before invasive facet injections. Other symptomatic abnormal areas of tracer uptake were identified in 37% of patients. |
| Schwarzer et al 67 | Single-blind, placebo-controlled trial designed to evaluate the effects of CT-confirmed facet osteoarthritis on IA facet joint injections | 63 patients Median age 59 years (IQR 51–68); Female:male ratio 3:1 Median LBP duration 7 years (IQR 2–20) | 32% (95% CI 20 to 44) with ≥50% pain reduction at 3 hours following IA placebo injection 40% (95% CI 27 to 53) with ≥50% pain reduction at 3 hours following IA LA injection No significant group differences in CT joint scores based on patient response to IA placebo or IA LA injections | CT not recommended in the diagnostic evaluation of facet pain. |
| Dolan et al 53 | Prospective comparison of IA facet joint injections between patients with SPECT (+) and SPECT (−) scans | SPECT (+) group=22 SPECT (−) group=36 | Significant improvement in VAS and McGill pain scores in SPECT (+) group at months 1 and 3 94% SPECT (+) group reported improvement at month 1 compared with 47% in SPECT (−) group | No significant improvements evident at month 6 47% of SPECT (+) patients had osteoarthritic facet joints compared with 18% of SPECT (−) group. |
| Pneumaticos et al 66 | Prospective comparison of IA facet joint injections between patients with SPECT (+) and SPECT (−) scans | SPECT (+) group=15 SPECT (−) group=16 No SPECT comparison group=16 | Significant improvement in pain at months 1 and 3 in SPECT (+) group vs SPECT (−) and no SPECT comparison groups Number of facet joints treated in SPECT (+) group reduced from 60 to 27 with cost savings of US$326/patient | No significant group differences at month 6. |
| Cohen et al 69 | Retrospective, multicenter study examining factors associated with cervical medial branch RFA outcomes | 92 patients, 44 with significant facet pathology on MRI | 57% success rate in overall cohort, 52% in individuals with significant MRI pathology (p=0.75) | Slightly higher success rate in the younger patients (ie, with less facet joint pathology) treated at Walter Reed may have contributed to findings. |
| Cohen et al 54 | Retrospective, multicenter study examining factors associated with lumbar medial branch RFA outcomes | 192 patients, 117 with significant facet pathology on MRI | 54% success rate in overall cohort, 52% in individuals with significant MRI pathology (p=0.75) | Slightly higher success rate in the younger patients (ie, with less facet joint pathology) treated at Walter Reed may have contributed to findings. |
| Ackerman and Ahmad61 | Randomized, double-blind trial of MBB vs IA facet joint injections in patients with SPECT (+) scans | IA facet injection group=23 (male=14, female=9) MBB group=23 (male=12, female=11); Median age=39.3 years Mean symptom duration=7.6 weeks | 61% had ≥50% pain relief at week 12 in IA facet injection group vs 26% in MBB group 26% Sensitivity/specificity of SPECT in the IA facet joint injection group 0.79 and 0.70, respectively Pain rating and ODI scores significantly less in the IA facet group vs MBB group at week 12 | All patients in the IA facet injection and MBB groups received lidocaine and triamcinolone. |
| Stojanovic et al 68 | Retrospective review of correlations between MRI and outcomes of MBB and RF denervation | 127 consecutive patients Male=52% Mean age=52.9 years | Facet joint degeneration or hypertrophy on MRI significantly correlated with ≥50% pain reduction following MBB but not RF Younger patients significantly more likely to fail MBB but not RF | Prospective studies recommended to confirm study findings. |
| Koh et al 65 | Prospective comparison of MBB between patients with SPECT (+) and SPECT (−) scans | SPECT (+) group=28 (male=12, female=16); SPECT (−) group=5 (male=2, female=3) Mean age SPECT (+) group=60.4 Mean age SPECT (−) group=51.8 years | 85.7% with >50% pain reduction at week 2 in SPECT (+) group vs 20% in the SPECT (−) group 78.6% with >50% pain reduction at week 4 in SPECT (+) group vs 0% in the SPECT (−) group No significant between-group differences in ODI | All MBB performed with ultrasound guidance using lidocaine and triamcinolone. |
| Freiermuth et al 62 | Randomized, double-blind, placebo-controlled trial to determine the sensitivity/specificity of SPECT/CT to identify patients with facet joint pain prior to IA facet injections | 29 patients (male=16, female=13) age range=38–83 years | SPECT/CT; sensitivity 0.57 (95% CI 0.18 to 0.90), specificity 0.77 (95% CI 0.55 to 0.92) Diagnostic accuracy=0.72 (ideal value 1.0) | SPECT/CT not recommended as first-line diagnostic tool prior to IA facet joint injections. |
| Jain et al 64 | Randomized, double-blind, controlled trial of SPECT/CT to identify patients most likely to respond to comparative LA low back injections (sacroiliac joint, facet joint) | SPECT/CT group=7 Control group (no SPECT)=14 | 71% with >50% pain reduction in SPECT/CT group vs 43% in the control group (p<0.05) immediately following MBB | Included patients with chronic LBP. Most common diagnoses were sacroiliitis, followed by L4-5 and L5-S1 facet arthropathy. |
| Sawicki et al 70 | Retrospective study to determine if PET/MRI could predict MBB responders | 10 patients with mechanical neck pain. 140 joints assessed. 6 joints in 6 patients had increased uptake of radioactive tracer and facet arthrosis, and 27 joints had arthrosis without increased uptake | The six patients with positive PET and MRI scans had better outcomes immediately after blocks, and through 3-month follow-up | Used 3 mL of LA and steroid per level. |
IA, intra-articular; LA, local anesthetic; LBP, low back pain; MBB, medial branch block; MRI, MRI resonance imaging; ODI, Oswestry Disability Index; PET, positron emission tomography; PS, planar scintigraphy; RF, radiofrequency; RFA, radiofrequency ablation; SPECT, single photon emission computed tomography; VAS, visual analog scale.