Efficacy of Cervical Medial Branch Block in Two Patients with Refractory Occipital Neuralgia.

Occipital neuralgia is often characterized by severe, paroxysmal and debilitating pain in the distribution of greater and lesser occipital nerve. It can cause severe refractory headache. Occipital nerve blocks have been used for long in diagnosis and treatment. We describe the efficacy of cervical medial branch block in patients with refractory occipital neuralgia. Two patients with refractory occipital neuralgia who were earlier treated with medications and occipital nerve block without much benefit were given cervical medial branch block. Visual analogue scale (VAS) score was checked for evaluation of effect of cervical medial branch block. The VAS score at 3 month after cervical medial branch block was significantly decreased compared to baseline scores in both patients. There were no major complications. Our case report suggests that cervical medial branch block can be used as a treatment modality in patients with refractory occipital neuralgia. This also suggests that cervical medial branches are important pain generators located in cervical region, could be an important source of pain in occipital neuralgia.

Intravascular injection in cervical medial branch block: an evaluation of 361 injections

BACKGROUND: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Cervical medial branch block (MBB) represents a useful interventional pain management procedure indicated in patients with a chronic neck pain of facet joint origin. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as pre-injection aspiration and intermittent fluoroscopy to avoid intravascular injections. METHODS: We prospectively examined 361 cervical MBBs in 158 patients performed by 2 physicians. Aspiration test, spot radiography, and contrast injection under real-time fluoroscopic visualization were performed sequentially without repositioning the needle. Incidences of blood flash back and the presence of intravascular contrast spread on spot radiographic images and during real-time fluoroscopy were checked. The factors studied for intravascular injection included patient age and sex and block spinal level. RESULTS: No specific factors were found to affect the incidence of intravascular uptake during block. The overall incidence of intravascular uptake was 3.3% per nerve block (12/361), and 7 of these were predicted by pre-injection aspiration (sensitivity = 58.3%) and 8 by spot radiography (sensitivity = 66.7%). CONCLUSIONS: The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during cervical MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.