Intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet MRI STIR signal. A prospective, multi-center case series

TL;DR

This study examines the effectiveness of corticosteroid injections in the cervical facet joints for neck pain patients with MRI signs of inflammation.

Contribution

The study provides new evidence on the short-term efficacy of cervical facet joint corticosteroid injections in patients with MRI-confirmed peri-facet edema.

Findings

64% of patients reported at least 50% pain improvement within 2-4 weeks post-injection.

Neck disability scores improved significantly in the short term but showed less improvement at 3 months.

Global perception of improvement was high in the short term but declined in the intermediate term.

Abstract

Intra-articular cervical facet joint corticosteroid injections are commonly performed, yet studies demonstrating benefit are limited.

To evaluate success rates of intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet edema as demonstrated by MRI with STIR sequences.

Preliminary, prospective, multi-center case series.

Thirty-three patients from three independent spine centers.

Consecutive patients were enrolled with axial neck pain and peri-facet joint edema on MRI with STIR sequences when undergoing intra-articular cervical facet joint corticosteroid injections. Outcomes were prospectively collected at 2-4-weeks and at 3-months post-injection. The primary outcome was the proportion of patients with at least 50 % improvement in the numeric rating scale (NRS) pain score. Neck disability index (NDI) and global perception of change (GPC) were evaluated as secondary outcomes.

At 2-4-weeks post-injection, 64 % [95 %CI: 46–79 %] of the 28 patients with follow-up data met criteria for success (≥50 % improvement in NRS). 86 % [95 %CI: 69–94 %] reported that they were better or much better on the GPC, and mean NDI improved from 19.3 to 8.9. At 3-months post-injection, 35 % [95 %CI: 19–54 %] of the 26 patients with follow-up data met criteria for success, and 50 % [95 %CI: 32–68 %] reported that they were better or much better on the GPC. Mean NDI at 3-months was 11.0.

Intra-articular cervical facet joint corticosteroid injections may provide short-term relief of neck pain in patients with peri-facet edema as demonstrated by MRI with STIR sequences. Intermediate-term results are less encouraging.

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