Therapeutic utility and long-term management strategy of cervical medial branch blocks in chronic facet-mediated pain: A systematic review.

Abstract

BackgroundCervical medial branch blocks (CMBBs) are widely used for chronic facet-mediated pain, yet their therapeutic role, duration of benefit, and optimal repeat intervals remain unclear.ObjectiveTo systematically evaluate therapeutic effectiveness, duration of benefit, and optimal repeat intervals of CMBBs for chronic cervical facet pain.MethodsSystematic search of MEDLINE, Embase, Web of Science, and Cochrane Library through November 2025. Inclusion: randomized controlled trials and observational studies reporting therapeutic outcomes of CMBBs in adults. Independent dual review with quality assessment using RoB 2 and ROBINS-I tools. Qualitative synthesis following SWiM guidelines was performed due to substantial heterogeneity in diagnostic protocols, intervention parameters, and outcome measures.ResultsEleven studies (4 RCTs, 7 observational; N > 1200 patients) demonstrated that 55-80% of patients achieved clinically meaningful benefit (≥50% pain relief). Median duration of analgesic effect ranged from 8-16 weeks, with bupivacaine showing longer duration than lidocaine. Repeated CMBBs at 3-4 month intervals maintained therapeutic effectiveness over 12-24 months without tachyphylaxis. No major complications were reported.ConclusionsModerate-certainty evidence supports CMBBs as effective therapeutic interventions providing short- to intermediate-term relief (8-16 weeks) for chronic cervical facet pain. An evidence-based repeat interval of 3-4 months maintains effectiveness without tachyphylaxis. CMBBs represent a safe, repeatable strategy, particularly when radiofrequency neurotomy is not feasible or preferred.Clinical RelevanceThis review provides evidence-based guidance for long-term CMBB management with practical repeat interval recommendations applicable to multidisciplinary spine and pain practice.