Studies comparing imaging modalities for cervical facet injections
| Author, year | Patient population | Study design | Results | Comments |
| Park et al 2017145 | Pts with injection-confirmed chronic cervical facet joint pain who received US-guided (n=68) or fluoroscopically-guided cervical MBB (n=58) | Retrospective | Both groups showed improvements, with no significant differences between groups for pain scores or responder rates | Compared with fluoroscopically-guided cervical MBB, US-guided cervical MBB was associated with a shorter performance time and fewer needle passes |
| Finlayson et al 2013136 | 40 pts undergoing TON block were randomized to fluoroscopic or US guidance | Randomized | Fluoroscopy and US guidance provided similar technical success rates (95–100%) and pain relief | US 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 2015147 | 50 pts undergoing C7 MBB under US or fluoroscopic guidance | Randomized | Similar accuracy rates (92–96%) and post-block pain relief between modalities | US guidance was associated with shorter performance time, fewer needle passes and less intravascular spread |
| Manchikanti et al 2012126 | 7500 episodes of 43 000 facet joint nerve blocks with 3370 episodes in the cervical region. All facet joint nerve blocks were performed under fluoroscopic guidance | Prospective observational | There were no major complications | For cervical MBB, 20% incidence of intravascular penetration |
| Zhou et al 2010167 | 31 pts with refractory cervicogenic headache who underwent fluoroscopically-guided AA and C2–3 facet joint injections and C2 and 3 dorsal rami blocks | Prospective observational | 28 (90.3%) pts experienced >50% headache relief after treatment, with an average duration of 21.7 (range 1–90) days | No treatment-related complications |
| Obernauer et al 2013143 | 40 pts (54 joints) with subacute axial neck pain were randomly assigned to US- or CT-guided IA facet injections | Randomized | Accuracy 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 levels | US-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.