The Specificity of Cervical Facet Medial Branch Blocks

NCT00613340 | Completed

• 1 other identifier: NA-20008-A
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Neck Pain; Cervical Facet Arthropathy

Keywords

Cervical pain; Zygapophysial joint; Specificity

Outcome Measures

Primary Outcomes (1)

• Accuracy of injections

  Immediately after nerve blocks.

Secondary Outcomes (1)

• Pain relief after nerve blocks

  8 hours after blocks

Study Arms (2)

1

EXPERIMENTAL

Cervical medial branch blocks with 0.25 ml of injectate

Procedure: Cervical medial branch blocks

2

EXPERIMENTAL

Cervical medial branch blocks with 0.5 ml of local anesthetic and contrast

Procedure: Cervical medial branch blocks

Interventions

Cervical medial branch blocks PROCEDURE

Cervical medial branch blocks done with 0.25 ml of local anesthetic and contrast

1

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

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

Sponsors & Collaborators

• Johns Hopkins University: lead
• Army Regional Anesthesia and Pain Management Initiative: collaborator

Study Sites (1)

Walter Reed Army Medical Center

Washington D.C., District of Columbia, 20307, United States

Location

Related Publications (3)

• 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.

  PMID: 9127924 RESULT

• 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.

  PMID: 8535040 RESULT

• 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.

  PMID: 19996954 DERIVED

MeSH Terms

Conditions

Neck Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Steven P Cohen, MD

  Walter Reed Army Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: January 31, 2008
• First Posted: February 13, 2008
• Study Start: January 1, 2008
• Primary Completion: April 1, 2009
• Study Completion: April 1, 2009
• Last Updated: August 7, 2009

Record last verified: 2009-08

Locations

US (1)