Table 5.

Studies evaluating the association between imaging pathology and facet joint block and treatment outcomes

Study	Design	Number of subjects	Results	Comments
Holder et al 63	Prospective study designed to evaluate the sensitivity and specificity of PS or SPECT scans in identifying patients responsive to IA facet injections	43 patients (male=17, female 26) Mean age 55 years (range 16–18 years)	PS group: sensitivity=0.71, specificity=0.76, (+) predictive value=0.38, (−) predictive value=0.93 SPECT group: sensitivity=1.0, specificity=0.71, (+) predictive value=0.41, (−) predictive value=1.0	The authors concluded that the high sensitivity and (−) predictive value made SPECT scan a valuable screening tool before invasive facet injections. Other symptomatic abnormal areas of tracer uptake were identified in 37% of patients.
Schwarzer et al 67	Single-blind, placebo-controlled trial designed to evaluate the effects of CT-confirmed facet osteoarthritis on IA facet joint injections	63 patients Median age 59 years (IQR 51–68); Female:male ratio 3:1 Median LBP duration 7 years (IQR 2–20)	32% (95% CI 20 to 44) with ≥50% pain reduction at 3 hours following IA placebo injection 40% (95% CI 27 to 53) with ≥50% pain reduction at 3 hours following IA LA injection No significant group differences in CT joint scores based on patient response to IA placebo or IA LA injections	CT not recommended in the diagnostic evaluation of facet pain.
Dolan et al 53	Prospective comparison of IA facet joint injections between patients with SPECT (+) and SPECT (−) scans	SPECT (+) group=22 SPECT (−) group=36	Significant improvement in VAS and McGill pain scores in SPECT (+) group at months 1 and 3 94% SPECT (+) group reported improvement at month 1 compared with 47% in SPECT (−) group	No significant improvements evident at month 6 47% of SPECT (+) patients had osteoarthritic facet joints compared with 18% of SPECT (−) group.
Pneumaticos et al 66	Prospective comparison of IA facet joint injections between patients with SPECT (+) and SPECT (−) scans	SPECT (+) group=15 SPECT (−) group=16 No SPECT comparison group=16	Significant improvement in pain at months 1 and 3 in SPECT (+) group vs SPECT (−) and no SPECT comparison groups Number of facet joints treated in SPECT (+) group reduced from 60 to 27 with cost savings of US$326/patient	No significant group differences at month 6.
Cohen et al 69	Retrospective, multicenter study examining factors associated with cervical medial branch RFA outcomes	92 patients, 44 with significant facet pathology on MRI	57% success rate in overall cohort, 52% in individuals with significant MRI pathology (p=0.75)	Slightly higher success rate in the younger patients (ie, with less facet joint pathology) treated at Walter Reed may have contributed to findings.
Cohen et al 54	Retrospective, multicenter study examining factors associated with lumbar medial branch RFA outcomes	192 patients, 117 with significant facet pathology on MRI	54% success rate in overall cohort, 52% in individuals with significant MRI pathology (p=0.75)	Slightly higher success rate in the younger patients (ie, with less facet joint pathology) treated at Walter Reed may have contributed to findings.
Ackerman and Ahmad61	Randomized, double-blind trial of MBB vs IA facet joint injections in patients with SPECT (+) scans	IA facet injection group=23 (male=14, female=9) MBB group=23 (male=12, female=11); Median age=39.3 years Mean symptom duration=7.6 weeks	61% had ≥50% pain relief at week 12 in IA facet injection group vs 26% in MBB group 26% Sensitivity/specificity of SPECT in the IA facet joint injection group 0.79 and 0.70, respectively Pain rating and ODI scores significantly less in the IA facet group vs MBB group at week 12	All patients in the IA facet injection and MBB groups received lidocaine and triamcinolone.
Stojanovic et al 68	Retrospective review of correlations between MRI and outcomes of MBB and RF denervation	127 consecutive patients Male=52% Mean age=52.9 years	Facet joint degeneration or hypertrophy on MRI significantly correlated with ≥50% pain reduction following MBB but not RF Younger patients significantly more likely to fail MBB but not RF	Prospective studies recommended to confirm study findings.
Koh et al 65	Prospective comparison of MBB between patients with SPECT (+) and SPECT (−) scans	SPECT (+) group=28 (male=12, female=16); SPECT (−) group=5 (male=2, female=3) Mean age SPECT (+) group=60.4 Mean age SPECT (−) group=51.8 years	85.7% with >50% pain reduction at week 2 in SPECT (+) group vs 20% in the SPECT (−) group 78.6% with >50% pain reduction at week 4 in SPECT (+) group vs 0% in the SPECT (−) group No significant between-group differences in ODI	All MBB performed with ultrasound guidance using lidocaine and triamcinolone.
Freiermuth et al 62	Randomized, double-blind, placebo-controlled trial to determine the sensitivity/specificity of SPECT/CT to identify patients with facet joint pain prior to IA facet injections	29 patients (male=16, female=13) age range=38–83 years	SPECT/CT; sensitivity 0.57 (95% CI 0.18 to 0.90), specificity 0.77 (95% CI 0.55 to 0.92) Diagnostic accuracy=0.72 (ideal value 1.0)	SPECT/CT not recommended as first-line diagnostic tool prior to IA facet joint injections.
Jain et al 64	Randomized, double-blind, controlled trial of SPECT/CT to identify patients most likely to respond to comparative LA low back injections (sacroiliac joint, facet joint)	SPECT/CT group=7 Control group (no SPECT)=14	71% with >50% pain reduction in SPECT/CT group vs 43% in the control group (p<0.05) immediately following MBB	Included patients with chronic LBP. Most common diagnoses were sacroiliitis, followed by L4-5 and L5-S1 facet arthropathy.
Sawicki et al 70	Retrospective study to determine if PET/MRI could predict MBB responders	10 patients with mechanical neck pain. 140 joints assessed. 6 joints in 6 patients had increased uptake of radioactive tracer and facet arthrosis, and 27 joints had arthrosis without increased uptake	The six patients with positive PET and MRI scans had better outcomes immediately after blocks, and through 3-month follow-up	Used 3 mL of LA and steroid per level.

IA, intra-articular; LA, local anesthetic; LBP, low back pain; MBB, medial branch block; MRI, MRI resonance imaging; ODI, Oswestry Disability Index; PET, positron emission tomography; PS, planar scintigraphy; RF, radiofrequency; RFA, radiofrequency ablation; SPECT, single photon emission computed tomography; VAS, visual analog scale.