An Updated Review of the Diagnostic Utility of
Cervical Facet Joint Injections
Authors: Datta Sukdeb 
Published: March 2021

Background: Chronic persistent neck pain with or without upper extremity pain is common in the
general adult population with a prevalence of 48% for women and 38% for men, with persistent
complaints in 22% of women and 16% of men. Multiple modalities of treatment are exploding
in managing chronic neck pain along with increasing prevalence. However, there is a paucity of
evidence for all modalities of treatments in managing chronic neck pain. Controlled studies have
supported the existence of cervical facet or zygapophysial joint pain in 36% to 60% in heterogenous
population of these patients. However, these studies also have shown false-positive results in 27%
to 63% of patients with a single diagnostic block.
Study Design: A systematic review of diagnostic cervical facet joint nerve blocks.
Objective: To evaluate and update the accuracy of diagnostic facet joint nerve blocks in the
diagnosis of facet joint pain.
Methods: A methodological quality assessment of included studies was performed using Quality
Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50%
of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are
presented descriptively and critically analyzed.
The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence
developed by the United States Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and EMBASE from
1966 to June 2012, and manual searches of the bibliographies of known primary and review articles.
Results: Overall, a total of 26 manuscripts were considered for diagnostic accuracy evaluation and
9 manuscripts for studies evaluating various factors influencing the diagnostic validity of facet joint
interventions. Based on 9 studies meeting the inclusion criteria utilizing 75% to 100% pain relief as the
criterion standard with controlled blocks, the evidence is good for diagnostic accuracy of cervical facet
joint pain, with a prevalence of 36% to 60% with a false-positive rate of 27% to 63% with a single
block. Based on 2 studies from the same group of authors, the evidence for 75% to 100% pain relief as
the criterion standard with a single block is limited. The evidence is limited for a single diagnostic block
with 50% to 74% pain relief as the criterion standard, whereas no studies were available assessing the
accuracy of 50% to 74% pain relief as the criterion standard with controlled blocks.
Limitations: The limitations of this systematic review include a paucity of literature on outcomes,
randomized, placebo-controlled trials and a lack of consensus on a gold standard.
Conclusions: Diagnostic cervical facet joint nerve blocks are safe, valid, and reliable. The strength
of evidence for diagnostic facet joint nerve blocks is good with the utilization of controlled diagnostic
blocks with at least 75% pain relief as the criterion standard; however, the evidence is limited for
single blocks or dual blocks for relief of 50% to 74% and single blocks with at least 75% pain relief.
Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medial branch
blocks, controlled comparative local anesthetic blocks