Table 14

Summary of studies on therapeutic benefits from cervical facet medial branch and intra-articular injections

Author, yearPatient populationDesignResultsComments
Dory et al
14 pts (22 joints) received IA injections with steroids for neck painProspective cohort study9 pts had pain relief for 3 days to 13 monthsDistension of the joint capsule provoked pain in 50% of pts
Bogduk et al 19888Pts 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 study17 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 199322747 pts with chronic neck pain received dual comparative TON or cervical MBB with lidocaine and bupivacaine.Prospective cohort study13 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 199410241 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 betamethasoneRCTNo long-term analgesic benefit in either group; median duration of 50% pain relief was 3 days in both groups15 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
50 pts with chronic neck pain after MVC who received triple comparative TON or cervical MBB with lidocaine, bupivacaine and salineProspective cohort study2 (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 2010231120 pts with neck pain who responded to comparative LA blocks were randomized to cervical MBB with LA and sarapin or with LA, sarapin and steroidRCTSimilar 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 2012223400 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)RCTIA injection cohort had increased cervical ROM, greater pain relief, and fewer headaches during the 1-year follow-upAnalgesic medications, trigger point injections with LA and botulinum, and home exercises used variably in both cohorts
Smith et al 20137390 pts with WAD grade II >6 months post-MVC who received dual IA facet injections and MBB (medications not noted); 30 healthy controlsCross-sectional study comparing physical and psychological profiles of 58 injection responders vs 32 non-respondersSimilar level of sensory disturbance, motor dysfunction, psychological distress in both groupsNo patient experienced pain relief for ≥3 months following IA facet injections
Lee et al
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 steroidProspective cohort study24 (54.5%) pts reported ≥2-point reduction in pain NRS or ≥50% overall improvement in pain; 9/44 (18%) underwent RFA11 pts required repeat IA injections in the 1-year study period with a mean interval of 6 weeks between injections
Hussain et al 202021560 pts with non-radiating neck pain received cervical MBB at two levels with LA and steroid or trigger point injections with LA and steroidRCTCervical 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 groupTechnique 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).