A Critical Look at the Data Supporting Ultrasound Guided Cervical Medial Branch Blocks

Meredith Barad

doi:10.30756/ahmj.2020.03.02

Abstract

According to guidelines published by the American Society of Interventional Pain Physicians in 2013 ‎1, ‎2, the current evidence for cervical facet joint injections is fair. Yet the volume of these procedures continues to rise ‎3. There is a need for a more critical appraisal of the benefit, technique and adverse effects associated with cervical spine injections. The systematic review and meta-analysis by Paredes et al ‎4 seeks to better assess the evidence for use of ultrasound (US) guidance with cervical medial branch blocks. This article is also a response to a recently published critique by Schneider et al ‎5 raising concerns about the paucity of evidence evaluating the safety, accuracy, and effectiveness of US-guided cervical spine procedures.

Highlights

Visualization of the needle tip can be difficult, leading to safety concerns as in the case report of a myelopathy that occurred during a C7 medial branch block performed with ultrasound guidance 6
While these two critiques are significant, Paredes et al note in their systematic review 4 that the benefit of US lies in decreased radiation to the patient, and potentially decreased costs in terms of equipment acquisition to perform the procedure, and decreased procedure time
It is important to recognize that the data for cervical facet interventions has been graded as fair in the past when using fluoroscopy or CT guidance

Summary

Introduction

A Critical Look at the Data Supporting Ultrasound Guided Cervical Medial Branch Blocks. According to guidelines published by the American Society of Interventional Pain Physicians in 2013 1, 2, the current evidence for cervical facet joint injections is fair. The systematic review and meta-analysis by Paredes et al 4 seeks to better assess the evidence for use of ultrasound (US) guidance with cervical medial branch blocks.

Results

Conclusion