Facet Joint Interventions Guidelines Released June 8, 2020

Manchikanti and 37 distinguished co-authors from multiple institutions have published “Comprehensive Evidence-based Guidelines for Facet Joint Interventions in Management of Chronic Spinal Pain (available at: https://pubmed.ncbi.nlm.nih.gov/32503359).” These guidelines included development of objectives and key questions with utilization of trustworthy standards. The evidence-based guidelines utilized comprehensive literature pertaining to all aspects of facet joint interventions with a best evidence synthesis of available literature and utilizing grading for recommendations.

Overall, these guidelines are 126 pages, with 20 figures, with 34 tables, and 687 references. These guidelines provided evidence-based recommendations starting from non-interventional diagnosis, imaging, to interventional diagnosis with facet joint injections and therapeutic interventions for all regions, with assessment of 3 modes of treatment – namely, intraarticular injections, medial branch blocks, and radiofrequency neurotomy.

Overall, evidence was Level II for diagnostic facet joint nerve blocks with moderate strength of recommendations in lumbar, cervical, and thoracic spine. For therapeutic facet joint interventions, it was variable with across the board Level II evidence, with moderate strength of recommendation for therapeutic medial branch blocks in all 3 regions. Level of evidence was II with moderate strength recommendation for lumbar and cervical radiofrequency neurotomy, whereas it was Level III with weak to moderate strength recommendation in the thoracic spine.

The evidence for intraarticular injections was highly variable from Level III to V with weak to moderate strength recommendations.

These guidelines were presented at recent CAC meeting hearings for facet joint interventions.