Table 10

Studies comparing imaging modalities for cervical facet injections

Author, yearPatient populationStudy designResultsComments
Park et al
Pts with injection-confirmed chronic cervical facet joint pain who received US-guided (n=68) or fluoroscopically-guided cervical MBB (n=58)RetrospectiveBoth groups showed improvements, with no significant differences between groups for pain scores or responder ratesCompared with fluoroscopically-guided cervical MBB, US-guided cervical MBB was associated with a shorter performance time and fewer needle passes
Finlayson et al 201313640 pts undergoing TON block were randomized to fluoroscopic or US guidanceRandomizedFluoroscopy and US guidance provided similar technical success rates (95–100%) and pain reliefUS guidance was associated with a significantly shorter performance time (212.8 vs 396.5 seconds) and fewer needle passes (2 vs 6)
Finlayson et al 201514750 pts undergoing C7 MBB under US or fluoroscopic guidanceRandomizedSimilar accuracy rates (92–96%) and post-block pain relief between modalitiesUS guidance was associated with shorter performance time, fewer needle passes and less intravascular spread
Manchikanti et al 20121267500 episodes of 43 000 facet joint nerve blocks with 3370 episodes in the cervical region. All facet joint nerve blocks were performed under fluoroscopic guidanceProspective observationalThere were no major complicationsFor cervical MBB, 20% incidence of intravascular penetration
Zhou et al 201016731 pts with refractory cervicogenic headache who underwent fluoroscopically-guided AA and C2–3 facet joint injections and C2 and 3 dorsal rami blocksProspective observational28 (90.3%) pts experienced >50% headache relief after treatment, with an average duration of 21.7 (range 1–90) daysNo treatment-related complications
Obernauer et al 201314340 pts (54 joints) with subacute axial neck pain were randomly assigned to US- or CT-guided IA facet injectionsRandomizedAccuracy of US-guided interventions was 100%. Mean time (min:sec) to final needle placement in the US group was 04:46 vs 11:12 (p<0.05) in the CT group for one injected level, and 05:49 in the US group vs 14:32 (p<0.05) in the CT group for two injected levelsUS-guided single-level IA injections resulted in slightly greater pain relief immediately 1-month post-procedure compared with CT-guided injections. For two-level injections, pain reduction was comparable
  • AA, atlanto–axial; CT, computed tomography; IA, intra-articular; MBB, medial branch block; pts, patients; TON, third occipital nerve; US, ultrasound.