Systematic Review of Diagnostic Utility and
Therapeutic Effectiveness of Thoracic Facet
Joint Interventions
Authors: Atluri Sairam 
Published: March 2021

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of the patients based on the responses to controlled diagnostic blocks. Systematic
reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain, moderate evidence for therapeutic thoracic medial branch blocks, and limited evidence for radiofrequency neurotomy of therapeutic
facet joint nerves.
Objectives: To determine the clinical utility of diagnostic and therapeutic thoracic facet joint interventions in diagnosing and managing chronic upper back and mid back pain.
Study Design: Systematic review of diagnostic and therapeutic thoracic facet joint interventions.
Methods: Review of the literature for utility of facet joint interventions in diagnosing and managing facet
joint pain was performed according to the Agency for Healthcare Research and Quality (AHRQ) criteria for
diagnostic studies and observational studies and the Cochrane Musculoskeletal Review Group criteria as
utilized for interventional techniques for randomized trials. The level of evidence was classified as Level I, II,
or III based on the quality of evidence developed by United States Preventive Services Task Force (USPSTF) for
therapeutic interventions. Recommendations were based on the criteria developed by Guyatt et al.
Data sources included relevant literature of the English language identified through searches of Medline and EMBASE from 1966 to July 2008 and manual searches of bibliographies of known primary
and review articles. Results of the analysis were performed for diagnostic and therapeutic interventions separately.
Outcome Measures: For diagnostic interventions, studies must have been performed utilizing controlled local anesthetic blocks. For therapeutic interventions, the primary outcome measure was pain
relief (short-term relief = up to 6 months and long-term relief > 6 months) with secondary outcome
measures of improvement in functional status, psychological status, return to work, and reduction in
opioid intake.
Results: Based on the controlled comparative local anesthetic blocks, the evidence for the diagnosis
of thoracic facet joint pain is Level I or II-1.
The evidence for therapeutic thoracic medial branch blocks is Level I or II-1. The recommendation is IA
or 1B/strong for diagnostic and therapeutic medial branch blocks.
Conclusion: The evidence for the diagnosis of thoracic facet joint pain with controlled comparative
local anesthetic blocks is Level I or II-1.
The evidence for therapeutic facet joint interventions is Level I or II-1 for medial branch blocks.
Recommendation is 1A or 1B/strong for diagnostic and therapeutic medial branch blocks.
Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint
pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks,
therapeutic thoracic medial branch blocks, thoracic radiofrequency neurotomy, thoracic intraarticular
facet joint injections