Ultrasound-guided treatment of cervical facet joint pain: a retrospective comparison of repeated medial branch blocks and pulsed radiofrequency

Aims: Ultrasound-guided cervical medial branch interventions are increasingly used for chronic facet-mediated neck pain, yet comparative data between serial cervical medial branch blocks (CMBB) and pulsed radiofrequency (pRF) under ultrasound guidance are limited. This study compared the short- and medium-term clinical outcomes of repeated ultrasound-guided CMBB with those of single-session ultrasound-guided pRF in patients with chronic cervical facet joint pain. Methods: In this retrospective cohort, 104 patients with clinically and radiologically confirmed cervical facetogenic pain who exhibited ?50% temporary pain relief after diagnostic medial branch blocks were analyzed. Patients underwent either four weekly ultrasound-guided CMBBs with 0.25% bupivacaine (n = 45) or a single ultrasound-guided pRF procedure targeting the cervical medial branches (n = 59). Pain intensity (Numeric Rating Scale, NRS), neck-related disability (Neck Disability Index, NDI), and average daily analgesic tablet intake were assessed at baseline and at 1, 3, and 6 months. Responder status was defined as ?50% reduction in NRS and/or ?40% improvement in NDI. Results: Both CMBB and pRF produced significant within-group improvements in NRS, NDI, and analgesic consumption over 6 months (all p < 0.001). CMBB yielded faster symptomatic relief, with lower NRS scores at 1 and 3 months (4.16 ± 1.55 vs. 4.69 ± 1.59, p = 0.045; and 4.44 ± 1.39 vs. 4.36 ± 2.31, p = 0.043) and higher early NRS responder rates at 1 month (77.8% vs. 50.8%, p = 0.009). At 6 months, pain, disability, and analgesic use were comparable between groups, and NDI responder rates converged (62.2% vs. 66.1%, p = 0.839). Hedges’ g values indicated small-to-moderate between-group effect sizes favoring CMBB in the early phase (up to -0.65). No significant complications occurred; minor adverse events were infrequent and self-limiting in both groups. Conclusion: Both repeated ultrasound-guided CMBB and single-session ultrasound-guided pRF are effective, safe, and feasible options for chronic cervical facet joint pain. CMBB provides more rapid, clinically meaningful improvement, whereas pRF offers comparable medium-term outcomes and may be preferable in patients unable to attend repeated procedures. These findings support individualized treatment selection based on clinical profile, comorbidities, and logistical constraints, and highlight the need for prospective randomized trials to confirm and extend these results.