The benefit of therapeutic medial branch blocks after cervical operations

Background: persistent neck pain is a common problem after surgery of the cervical spine. no therapy recommendation exists for these patients. objectives: the objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. study design: retrospective practice audit. setting: review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. methods: patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). a positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. all patients with a minimum follow up time of 6 month were included. results: of the 312 operations performed,128 were artificial disc operations,125 were stand alone cages,and 59 were fusions with cage and plate. persistent neck pain occurred in 33.3 % of the patients. there was no difference between the patients with neck pain and the whole group of patients. more than half of the patients with neck pain-52.9%-were treated successfully with therapeutic medial branch blocks. since no further treatment was necessary,the initial treatment was considered successful. nearly a third-32.2%-of the patients were initially treated successfully,but their pain recurred and further diagnostics and treatments were necessary. in this group of patients,significantly more with double level operations were found (p = 0.003). patients not responding to the medial branch block were 14.9%. limitations: this audit is retrospective and observational,and therefore does not represent a high level of evidence. however,to our knowledge,since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists,it appears to be the best available research upon which to recommend treatment and to plan higher quality studies. conclusions: for persistent postsurgical neck pain only limited therapy recommendations exist. this study suggests treating these patients in a first instance with therapeutic medial branch blocks. the success rate is 52.9 %.