The Specificity of Cervical Facet Medial Branch Blocks

Randomized Study Comparing the Accuracy and Specificity of Cervical Facet Medial Branch Blocks With 0.25 ml and 0.5 ml of Local Anesthetic

Cervical facet arthropathy is a common cause of chronic neck pain. The "gold standard" for diagnosis is either blocking the facet joints, or more commonly blocking the medial branch nerves that innervate the joints. However, many studies have found a high false-positive rate when the nerves are blocked using 0.5 ml of local anesthetic. We will randomize patients to receive either cervical facet medial branch blocks with 0.25 ml of local anesthetic and contrast, or 0.5 ml. We will then do a CT scan to determine the accuracy and specificity of each block. Our hypothesis is that using the higher volume (0.5 ml) might be responsible for the high false-positive rate.

Study Overview

• Status: Completed
• Conditions: Neck Pain; Cervical Facet Arthropathy
• Intervention / Treatment: Procedure: Cervical medial branch blocks; Procedure: Cervical medial branch blocks

Detailed Description

Inclusion criteria: Dept. of Defense beneficiaries > 18 years of age; neck pain > 3 months duration; cervical paraspinal tenderness Exclusion criteria: Radicular signs or symptoms; use of anticoagulants or bleeding disorder.

Outcome measures: The number of blocks whereby the contrast bathes the target nerve; the number of blocks whereby the contrast spreads to the medial branch nerve at the adjacent spinal level; the number of times the contrast diffuses into the intervertebral foramen or epidural space. We will also compare pain relief over 8 hours following the block between both volumes.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington, District of Columbia, United States, 20307
      • Walter Reed Army Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age > 18 years
• Chronic neck pain > 3 months
• Paraspinal tenderness

Exclusion Criteria:

• Absence of radicular symptoms
• No bleeding diathesis
• Contrast allergy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Cervical medial branch blocks with 0.25 ml of injectate	Procedure: Cervical medial branch blocks; Cervical medial branch blocks done with 0.25 ml of local anesthetic and contrast; Procedure: Cervical medial branch blocks; Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast
Experimental: 2; Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast	Procedure: Cervical medial branch blocks; Cervical medial branch blocks done with 0.25 ml of local anesthetic and contrast; Procedure: Cervical medial branch blocks; Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Accuracy of injections	Immediately after nerve blocks.

Secondary Outcome Measures

Outcome Measure	Time Frame
Pain relief after nerve blocks	8 hours after blocks

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: Army Regional Anesthesia and Pain Management Initiative
• Investigators: Principal Investigator: Steven P Cohen, MD, Walter Reed Army Medical Center

Publications and helpful links

General Publications

• Dreyfuss P, Schwarzer AC, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine (Phila Pa 1976). 1997 Apr 15;22(8):895-902. doi: 10.1097/00007632-199704150-00013.
• Lord SM, Barnsley L, Bogduk N. The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain. 1995 Sep;11(3):208-13. doi: 10.1097/00002508-199509000-00008.
• Cohen SP, Strassels SA, Kurihara C, Forsythe A, Buckenmaier CC 3rd, McLean B, Riedy G, Seltzer S. Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology. 2010 Jan;112(1):144-52. doi: 10.1097/ALN.0b013e3181c38a82.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): April 1, 2009
• Study Completion (Actual): April 1, 2009

Study Registration Dates

• First Submitted: January 31, 2008
• First Submitted That Met QC Criteria: February 12, 2008
• First Posted (Estimate): February 13, 2008

Study Record Updates

• Last Update Posted (Estimate): August 7, 2009
• Last Update Submitted That Met QC Criteria: August 5, 2009
• Last Verified: August 1, 2009

More Information

Terms related to this study

• Keywords: Specificity; Cervical pain; Zygapophysial joint
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: NA-20008-A