Table 13

Studies evaluating the accuracy of different approaches for cervical MBBs

Author, yearPatient populationDesignResultsComments
Cohen et al 20107824 pts with axial neck pain. Evaluated the accuracy and safety of posterior vs lateral approach for cervical MBBsRCT, radiologist blindedNo difference in target specificity of TON and C3–C7 MBBs when comparing lateral to posterior approachOnly RCT to directly compare posterior vs lateral approach for TON and cervical MBBs
SIS guidelines18N/AGuidelinesLateral approach recommended for TON and C3–C7 MBBsExpert consensus regarding cervical MBB approach based on literature review
Finlayson et al 201313640 pts undergoing TON block with US vs fluoroscopy using a posterior approachRCTIA spread of contrast and vascular breach occurred in 15% and 10% of participants, respectively, with the posterior fluoroscopic approach vs 0% with USNo comparison of posterior vs lateral approach
Wahezi et al 2019187C4–6 cervical MBBs using a posterior approach with 0.25 or 0.50 mL of injectate. Post-injection (CT) imaging and gross dissection performed to assess injectate spreadCadaveric study (n=6, 18 MBBs)0.25 mL volume was target-specificNo comparison of posterior vs lateral approach
Verrills et al 20081944134 cervical MBBs (number of pts not noted)Retrospective cohort study3.9% rate of vascular uptake associated with the lateral approachNo comparison of posterior vs lateral approach. Posterior approach noted to be used ‘at times on lower cervical joints’
Jeon et al 2015134178 cervical MBBs in 72 ptsProspective cohort study10.7% rate of vascular uptake associated with the lateral approach (as detected by DSA)No comparison of posterior vs lateral approach
Elgueta et al 2018162500 pts with CT angiograms of the head and neckRetrospective cohort studyVertebral artery loop located in the typical location of a TON block in 5–8% of individualsSafety implications with anterior needle trespass during TON blocks
  • CT, computed tomography; DSA, digital subtraction angiography; MBB, medial branch block; RCT, randomized controlled trial; TON, third occipital nerve.