Table 13.
Studies evaluating the accuracy of different approaches for cervical MBBs
| Author, year | Patient population | Design | Results | Comments |
| Cohen et al 201078 | 24 pts with axial neck pain. Evaluated the accuracy and safety of posterior vs lateral approach for cervical MBBs | RCT, radiologist blinded | No difference in target specificity of TON and C3–C7 MBBs when comparing lateral to posterior approach | Only RCT to directly compare posterior vs lateral approach for TON and cervical MBBs |
| SIS guidelines18 | N/A | Guidelines | Lateral approach recommended for TON and C3–C7 MBBs | Expert consensus regarding cervical MBB approach based on literature review |
| Finlayson et al 2013136 | 40 pts undergoing TON block with US vs fluoroscopy using a posterior approach | RCT | IA spread of contrast and vascular breach occurred in 15% and 10% of participants, respectively, with the posterior fluoroscopic approach vs 0% with US | No comparison of posterior vs lateral approach |
| Wahezi et al 2019187 | C4–6 cervical MBBs using a posterior approach with 0.25 or 0.50 mL of injectate. Post-injection (CT) imaging and gross dissection performed to assess injectate spread | Cadaveric study (n=6, 18 MBBs) | 0.25 mL volume was target-specific | No comparison of posterior vs lateral approach |
| Verrills et al 2008194 | 4134 cervical MBBs (number of pts not noted) | Retrospective cohort study | 3.9% rate of vascular uptake associated with the lateral approach | No comparison of posterior vs lateral approach. Posterior approach noted to be used ‘at times on lower cervical joints’ |
| Jeon et al 2015134 | 178 cervical MBBs in 72 pts | Prospective cohort study | 10.7% rate of vascular uptake associated with the lateral approach (as detected by DSA) | No comparison of posterior vs lateral approach |
| Elgueta et al 2018162 | 500 pts with CT angiograms of the head and neck | Retrospective cohort study | Vertebral artery loop located in the typical location of a TON block in 5–8% of individuals | Safety implications with anterior needle trespass during TON blocks |
CT, computed tomography; DSA, digital subtraction angiography; MBB, medial branch block; RCT, randomized controlled trial; TON, third occipital nerve.