Table 15.
Studies reporting bilateral and/or multi-level cervical medial branch blocks or radiofrequency ablation
| Author, year | Patient population | Design | Number treated | Bilateral treatments (cases) |
Number of joints treated (cases) | Adverse events |
| Lord et al 199668 | Pts with chronic whiplash disorder treated with MBB
and medial branch RFA (C2–3 joint was excluded from ablation) |
RCT (C2–3 joint was excluded from ablation) | Blocks: 24 pts Ablations:12 pts |
All blocks: Bilateral C2–3 plus C5–6 and ipsilateral C6–7 (1) Unilateral C2–3 and contralateral C5–6 (2) |
Unilateral blocks: 1 (18) 2 (2) 3 (1) Ablation: 1 (12) Bilateral blocks: 1 & 1 (2) 2 & 3 (1) Ablation: 0 |
Cutaneous dysesthesia or numbness was reported in 4 cases |
| Lord et al 1998202 | Cervical facet joint pain | Retrospective | Ablations: C2–3 joint: 12 pts (25 procedures) Lower cervical facet joints: 28 pts (48 procedures) |
Not reported | C2–3 (25) 1 (40) 2 (8) |
Vasovagal 2% Postoperative pain 97% Ataxia, special disorientation, unsteadiness 23% Cutaneous numbness C2–3 88% C3–4 80% Lower joints19% Dysesthesia C2–3 56% C3–4 30% Lower joints 17% Transient neuritis 2% Dermoid cyst 1% Köbner’s phenomenon 1% |
| Govind et al 2003307 | Cervicogenic headache | Prospective cohort | Ablations: 49 pts (51 procedures) |
Bilateral C2–3 ablations (2), each side was treated on separate days | Unilateral C2–3 ablation (47) |
Numbness 97% Ataxia 95% Dysesthesia 55% (all self-limiting/no intervention needed) |
| Barnsley, 2005101 | Chronic neck pain | Retrospective | Ablations: 35 pts (47 procedures) |
2 joints were treated in 3 cases. It is unclear if they were ipsilateral or contralateral | C2–3 (23) 1 (21) 2 (3) |
Nearly all had postoperative pain, lasting 1 week in most patients. 1 case of local wound infection |
| Manchikanti, 2006415 | Chronic neck pain | RCT | Blocks: 60 pts |
75% cases | 2 (48%) 3 (50%) 4 (2%) |
Not reported |
| Shin et al 2006285 | Chronic neck pain | Retrospective | Ablations: 28 pts (6 excluded as only one medial branch nerve of a facet joint was recorded as treated) |
8 | Unilateral 1 (3) 2 (9) 3 (4) Bilateral 1 & 1 (1) 1 & 3 (1) 2 & 1 (1) 2 & 2 (1) 2 & 3 (1) 3 & 3 (1) |
Muscle cramping pain and numbness lasting <4 weeks, in a majority of cases, <2 weeks |
| Manchukonda et al 2007416 | Chronic neck pain | Retrospective | Blocks: 251 pts |
180 | 2 (127) 3 (122) 4 (2) |
None reported |
| Klessinger, 2010313 | Pts had previous anterior cervical operations | Retrospective | Ablations: 32 pts |
10 | Unilateral: 1 (4) 2 (15) 3 (3) Bilateral: 1 & 1 (2) 2 & 2 (8) |
Not reported |
| MacVicar et al 201269 | Chronic neck pain | Prospective cohort | Ablations: 104 pts |
6 | Unilateral: C2–3 (29) 1 (54) 2 (16) 3 (5) Bilateral: C2–3 (1) 1 & 1 (3) 1 & 2 (2) |
Not reported |
| Hamer and Purath, 2014306 | Cervicogenic headache | Retrospective | Ablations: 17 pts C2/3 joint ±C2 DRG |
8 | Unilateral C2–3 (4) C2–3 & C2 DRG (5) Bilateral C2–3 (4) C2–3 & C2 DRG (4) |
Dizziness (1) and suboccipital hyperesthesia (2) (in one unilateral and one bilateral C2/3 ablation case) |
| Van Eerd et al 2014298 | Chronic neck pain (excluding whiplash and C2–3 joint involvement) |
Retrospective | Ablations: 65 pts |
0 | 2 (65) | Not reported |
| Hahn et al 2018417 | Chronic neck pain and vertigo | Retrospective | Blocks: 178 pts |
142 | Specific information lacking | Not reported |
| Van Eerd et al 202028 | Chronic neck pain | RCT | 76 pts Blocks (39) Ablations (37) |
0 | Unilateral 2 joints per patient (same
session) Blocks: C3–4 & C4–5: 9 C4–5 & C5–6: 25 C5–6 & C6–7: 5 Ablations: C3–4 & C4–5: 5 C4–5 & C5–6: 26 C5–6 & C6–7: 6 |
3 serious adverse events (lung cancer, brain tumor, atrial fibrillation) unrelated to treatment |
DRG, dorsal root ganglion; MBB, medial branch block; RCT, randomized controlled trial; RFA, radiofrequency ablation.