Comparative study between cervical medial branch radiofrequency ablation versus radiofrequency plus superficial cervical plexus block in treatment of the cervical facet and cervical spondylosis pain

Background & objective: Neck pain is one of the common problems due to long office hours and improper posture. While most of the pain originates from the muscles and is usually self-limiting, chronic pain which is resistant to treatment is very common especially with the cervical spondylosis. It is the most common progressive disorder in the aging cervical spine and may produce direct neurological damage or ischemic changes and, thus, lead to spinal cord disturbances. Cervical facet medial branch radiofrequency ablation (RFA) is a minimal procedure for the pain originating from the cervical facets. The procedure is very safe and needs no hospital stay with a success rate over 80% of the patients. We compared the efficacy in the pain relief between RFA of the medial branch of the cervical facet alone vs combined with superficial cervical plexus block (SCPB). Methodology: We used Power Analysis and Sample Size Software (PASS 15) (Version 15.0.10) for sample size calculation, setting confidence level at 90%, margin of error + 0.10. A total of 53 patients, seeking treatment for bilateral cervical spondylosis pain were included in the study conducted between March 2024 and June 2024. All of them received RFA on both sides; and after 2 weeks they received superficial cervical plexus block on one side. Numeric pain scale (NPS) was used to assess the pain at 1 and 6 months after the procedure. Patient Global Impression of Change (PGIC) score was also measured. Primary outcome was to measure the efficacy of the standard RFA in managing the cervical facet pain; secondary outcome was to assess any additive value of SCP block. Results: Neck pain significantly reduced on both sides after radiofrequency ablation of cervical facet medial branch after 1 month and after 6 months (P < 0.001), with no significant added effect of superficial cervical plexus block. PGIC was compared between both sides. Significant improvement was detected in both sides after treatment. However, the difference between the groups was not statistically significant. Conclusion: Radiofrequency alone can provide sufficient pain relief in patients with chronic neck spondylosis pain with no significant added effect of superficial cervical plexus block. Keywords: Neck pain, Radiofrequency, Cervical plexus block, Spondylosis, Chronic pain Citation: Daniel SH, Zakhary LE, El-Komos PM. Comparative study between cervical medial branch radiofrequency ablation versus radiofrequency plus superficial cervical plexus block in treatment of the cervical facet and cervical spondylosis pain. Anaesth. pain intensive care 2025;29(2):325-330. DOI: 10.35975/apic.v29i2.2583 Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025