. 2020 Apr 3;45(6):424–467. doi: 10.1136/rapm-2019-101243

Table 6.

Studies and reviews comparing lumbar medial branch blocks and intra-articular injections as prognostic tools before denervation therapy

Study	Design/Study type	Number of patients	Diagnostic interventions	Results	Comments
Birkenmaier et al ¹⁴⁵	Randomized	41, 26 (13 in each group) who had a positive block and received cryodenervation	MBB with 1 mL bupivacaine or pericapsular injections with 2 mL before lumbar facet cryodenervation	MBB>IA at 6 weeks and 3 months	Differences favoring MBB non-significant at 6 months.
Cohen et al ¹³⁴	Case-control	511 who under MBB (n=212), IA (n=212) or MBB and IA (n=87) before RFA	MBB with 0.5–0.75 mL LA or IA with 0.5–1 mL LA+steroid	MBB>IA or MBB+IA at 3 months	In patients who received double-blocks, MBB>IA+MBB≥IA.
Cohen et al ¹⁸	Two-phase, randomized	228 who underwent prognostic blocks, 135 who received RFA	0.5 mL MBB with LA and steroid, 0.5 mL IA injection or saline injection	Both MBB and IA >saline through 6 months, but no difference between MBB and IA injections	Those in the MBB and IA groups with a (+) prognostic block received RFA, while everyone in the saline group was treated.
van Zundert et al ¹⁴²	Narrative review	7 randomized studies, 349 patients	Indirect comparison of studies using IA and MBB blocks as screening tests before RFA	MBB>IA as screening test before lumbar facet RFA	Did not perform meta-analysis.
Practice Guidelines, Bogduk, ed¹⁶	Guidelines	Not noted	Indirect comparison of studies using IA and MBB blocks as screening tests before RFA	MBB>IA as screening test before lumbar facet RFA	Based on lack of validation for IA injections.

IA, intra-articular; LA, local anesthetic; MBB, medial branch block; RFA, radiofrequency ablation