The Specificity of Cervical Facet Medial Branch Blocks

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Neck Pain, Cervical Facet Arthropathy

Intervention / Treatment
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* Procedure: Cervical medial branch blocks
* Procedure: Cervical medial branch blocks


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years Chronic neck pain > 3 months Paraspinal tenderness Exclusion Criteria: Absence of radicular symptoms No bleeding diathesis Contrast allergy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Cervical medial branch blocks with 0.25 ml of injectate | Procedure: Cervical medial branch blocks<br>* Cervical medial branch blocks done with 0.25 ml of local anesthetic and contrast<br>|
| Experimental: 2<br>Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast | Procedure: Cervical medial branch blocks<br>* Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast<br>|

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain relief after nerve blocks |  | 8 hours after blocks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cervical pain, Zygapophysial joint, Specificity