Abstract
Objective: Cervical medial branch blocks (CMBBs) are useful in differentiating facetogenic pain from other sources of cervicogenic headaches and neck pain. The purpose of this systematic review and meta-analysis is to determine the efficacy, performance time, pain reduction, and adverse events associated with ultrasound (US) guided CMBB compared with other commonly used guidance methods such as fluoroscopy and computed tomography (CT). Methods: Searches of MEDLINE, EMBASE, Cochrane Library, and Ovid were completed to identify studies addressing CMBBs utilizing ultrasound compared to other imaging techniques. Three reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. Outcomes of interest including success rate, efficacy, performance time and complication profile were analyzed in meta-analysis. All other reported measures and complication profiles were analyzed descriptively. Results: A total of 9 studies were included. Four randomized controlled trials (RCTs) and 5 cohort studies satisfied inclusion criteria. US-guided CMBBs demonstrated similar success rates (OR = 1.05, 95% CI = 0.15 to 7.52, z = 0.05, P = 0.96) and similar pain efficacy (SMD = -0.54, 95% CI = -1.91 to 0.83, z = - 0.77, P = 0.44) compared to traditional guidance techniques. However, US-guided CMBBs demonstrated reduced performance time (SMD = -1.77, 95% CI = -2.65 to -0.89, z = -3.94, P <0.01) and rate of vascular injury/injection (OR = 0.09, 95% CI = 0.01 to 0.75, z = -2.23, P = 0.03) compared to fluoroscopy guided CMBBs. Conclusion: This review and meta-analysis demonstrated that US-guided cervical medial branch blocks are a reliable alternative to fluoroscopy- and CT-guided CMBBs, with similar efficacy but a potentially improved safety and performance time.
Highlights
Chronic neck pain is the fourth most common cause of years lived with disability worldwide 1
US-guided Cervical medial branch blocks (CMBBs) demonstrated similar success rates (OR = 1.05, 95% confidence interval (CI) = 0.15 to 7.52, z = 0.05, P = 0.96) and similar pain efficacy (SMD = -0.54, 95% CI = -1.91 to 0.83, z = 0.77, P = 0.44) compared to traditional guidance techniques
US-guided CMBBs demonstrated reduced performance time (SMD = 1.77, 95% CI = -2.65 to -0.89, z = -3.94, P
Summary
Chronic neck pain is the fourth most common cause of years lived with disability worldwide 1. Cervical medial branch blocks (CMBBs) involve anesthetizing the neural supply to the cervical facet joints, typically at several levels [2, 6, 7] These blocks provide essential diagnostic information regarding the anatomic pain generators and predict the response to subsequent radiofrequency ablation that can result in sustained pain relief for up to 12-18months [2, 6, 7]. As such, these procedures necessitate the need for reliability, safety and time efficiency [8, 9, 10]
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