Background: Cervical therapeutic intraarticular facet joint injections, therapeutic medial branch
blocks, and radiofrequency neurotomy have been applied in managing chronic neck pain of cervical
facet joint origin. However, the effectiveness of these modalities continues to be debated.
The purpose of this study was to determine the clinical effectiveness of therapeutic cervical medial
branch blocks with or without steroids.
Study Design: A randomized, double-blind, controlled trial.
Setting: An interventional pain management practice, a specialty referral center, a private practice
setting in the United States.
Objective: To evaluate the clinical outcomes of therapeutic cervical medial branch blocks with local
anesthetic with or without steroids in managing chronic neck pain of facet joint origin.
Methods: A total of 120 patients meeting inclusion criteria were included. All of the patients met the
diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks,
with at least 80% relief. Group I consisted of cervical medial branch blocks with bupivacaine only and
Group II consisted of cervical medial branch blocks with bupivacaine and steroid.
Therapeutic cervical medial branch blocks with local anesthetic with or without steroids were
administered. Main outcome measures included numeric pain scores, Neck Disability Index (NDI), opioid
intake, and work status evaluated at baseline, 6, 12, 18, and 24 months. The one-year results of
outcomes were published in 2008. This manuscript describes the 2-year results.
Significant improvement was defined as at least 50% improvement in pain relief and/or functional
status improvement.
Outcomes Assessment: Patient outcomes were measured at baseline, 3, 6, 12, 18, and 24 months
post-treatment with the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status,
and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant.
Results: Eighty-five percent of patients in Group I and 93% of patients in Group II showed significant
pain relief (≥ 50%) at 2 years. The average number of treatments for 2 years was 5.7. The duration
of average pain relief with each procedure was 17-19 weeks on average in both groups. Significant
improvement of pain and function was demonstrated for 83 to 89 weeks over a period of 2 years.
Limitations: The study limitations include the lack of a placebo group.
Conclusions: In this study, therapeutic cervical medial branch blocks instituted after the diagnosis, with
controlled comparative local anesthetic blocks with 80% concordant pain relief, repeated approximately 6
times over a period of 2 years, provided significant improvement over a period of 2 years.
Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, facet joint nerve or medial branch
blocks, comparative controlled local anesthetic blocks, therapeutic cervical facet joint nerve blocks
Effectiveness of Cervical Medial Branch Blocks in Chronic
Neck Pain: A Prospective Outcome Study
