Summary of studies on therapeutic benefits from cervical facet medial branch and intra-articular injections
| Author, year | Patient population | Design | Results | Comments |
| Dory et al 1983204 | 14 pts (22 joints) received IA injections with steroids for neck pain | Prospective cohort study | 9 pts had pain relief for 3 days to 13 months | Distension of the joint capsule provoked pain in 50% of pts |
| Bogduk et al 19888 | Pts with neck pain received cervical medial branch or TON block with LA (n=24) and IA injections with LA and steroids (n=8) | Prospective cohort study | 17 of 24 (71%) pts had pain relief for at least 2 hours with TON or MBB. 7 of 7 pts had pain relief with IA injections varying from 4 days to 12 months (median 1 month) | 1 pt had relief of headaches for over 1 month |
| Barnsley et al 1993227 | 47 pts with chronic neck pain received dual comparative TON or cervical MBB with lidocaine and bupivacaine. | Prospective cohort study | 13 of 47 (29%) pts had pain relief lasting longer than expected for either LA: 5 with lidocaine, 3 with bupivacaine, and 5 for both LA agents. | |
| Barnsley et al 1994102 | 41 pts with chronic neck pain following whiplash injury and a positive response to dual LA diagnostic cervical MBB received IA injections of either bupivacaine or betamethasone | RCT | No long-term analgesic benefit in either group; median duration of 50% pain relief was 3 days in both groups | 15 of 21 pts in the steroid group and 13 of 20 pts in the LA group had ≥50% pain relief for ≤10 days |
| Lord et al 1995189 | 50 pts with chronic neck pain after MVC who received triple comparative TON or cervical MBB with lidocaine, bupivacaine and saline | Prospective cohort study | 2 (4%) pts had ‘concordant prolonged’ response (pain relief >7 hours with lidocaine and/or >24 hours with bupivacaine, but longer with bupivacaine) | None of the ‘concordant prolonged’ response pts were placebo responders |
| Manchikanti et al 2010231 | 120 pts with neck pain who responded to comparative LA blocks were randomized to cervical MBB with LA and sarapin or with LA, sarapin and steroid | RCT | Similar responder rate (≥50% reduction in pain NRS scores) in both groups (85% for LA and sarapin, 93% for LA, sarapin and steroid) | Average number of treatments was 5.7 in 2 years. Co-interventions not controlled for |
| Park et al 2012223 | 400 pts with chronic neck pain secondary to myofascial and facet joint pathology were randomized to receive bilateral C5–6 and C6–7 IA facet injections with LA+steroid and conservative treatment (155 with 1-year follow-up) or conservative treatment alone (151 pts with 1-year follow-up) | RCT | IA injection cohort had increased cervical ROM, greater pain relief, and fewer headaches during the 1-year follow-up | Analgesic medications, trigger point injections with LA and botulinum, and home exercises used variably in both cohorts |
| Smith et al 201373 | 90 pts with WAD grade II >6 months post-MVC who received dual IA facet injections and MBB (medications not noted); 30 healthy controls | Cross-sectional study comparing physical and psychological profiles of 58 injection responders vs 32 non-responders | Similar level of sensory disturbance, motor dysfunction, psychological distress in both groups | No patient experienced pain relief for ≥3 months following IA facet injections |
| Lee et al 2018234 | 51 pts (44 with 1-year follow-up) with neck pain and positive dual diagnostic cervical MBB who received IA cervical facet injections with LA and steroid | Prospective cohort study | 24 (54.5%) pts reported ≥2-point reduction in pain NRS or ≥50% overall improvement in pain; 9/44 (18%) underwent RFA | 11 pts required repeat IA injections in the 1-year study period with a mean interval of 6 weeks between injections |
| Hussain et al 2020215 | 60 pts with non-radiating neck pain received cervical MBB at two levels with LA and steroid or trigger point injections with LA and steroid | RCT | Cervical MBB pts had mean pain score of 2.0 at 12 weeks vs 6.96 in trigger point injection group. Functional improvement also greater in MBB group | Technique for MBB and number of trigger point injections not noted |
IA, intra-articular injections; LA, local anesthetics; MBB, medial branch block; MVC, motor vehicle collision; NRS, numerical rating scale; pts, patients; RCT, randomized controlled trial; RFA, radiofrequency ablation; ROM, range of motion; TON, third occipital nerve; WAD, whiplash-associated disorder(s).