Comparative outcomes of ultrasound- and fluoroscopy-guided cervical medial branch pulsed radiofrequency in chronic facet joint pain: A retrospective cohort study
Çile Aktan1
, Ece Yanık2
1Department of Pain Medicine, Antalya Training and Research Hospital, Antalya, Türkiye
2Department of Neurology and Pain Medicine, Neuropsychiatry Center, Gazi University, Ankara, Türkiye
Keywords: Cervical medial branch, clinical outcomes, fluoroscopy, neck pain, pulsed radiofrequency, ultrasound-guided.
Abstract
Background: This study aims to compare clinical outcomes, procedural efficiency, and safety of pulsed radiofrequency (PRF) of the cervical medial branches performed under ultrasound (US) versus fluoroscopy (FL) guidance.
Patients and Methods: This single-center, retrospective cohort study included a total of 177 patients between January 2023 and June 2025. The patients were allocated to FL- (n = 75) or US-guided groups (n = 102). The Numeric Rating Scale (NRS), Neck Disability Index (NDI), and monthly analgesic use were assessed at baseline, at six weeks (primary endpoint), and at three and six months. The primary outcome inter-group NRS at six weeks was analyzed using analysis of covariance adjusted for baseline NRS, age, sex, bilaterality, and number of treated levels. Secondary outcomes included NDI, analgesic use, and procedural metrics. Six-week analyses included all patients; three- and six-month analyses used available-case data (up to n = 141). Last-observation-carried-forward (LOCF) sensitivity analyses were performed.
Results: Of the 177 patients included in the study, 60 were male and 117 were female with a mean age of 53.47 ± 5.46 (range, 39 to 66) years. Compared to FL, US-guided PRF was associated with shorter procedure times (8.64 ± 0.93 vs. 14.41 ± 2.24 min), fewer needle redirections (1.36 ± 0.50 vs. 3.56 ± 1.02), and fewer minor complications (11.8% vs. 30.7%) (p ≤ 0.003 for all). At six weeks, adjusted mean NRS was 4.46 in US group versus 4.56 in FL group, with no significant inter-group difference (adjusted difference 0.10; 95% confidence interval [CI]: −0.53 to 0.34). No significant differences were observed for NDI or analgesic use at any time point. Responder, longitudinal mixed-effects, and LOCF sensitivity analyses yielded concordant results.
Conclusion: Our study results suggest that US- and FL-guided cervical medial branch PRF can yield similar clinical outcomes. However, US guidance provides procedural and safety advantages without compromising effectiveness.
Cite this article as: Aktan Ç, Yanık E. Comparative outcomes of ultrasound- and fluoroscopy-guided cervical medial branch pulsed radiofrequency in chronic facet joint pain: A retrospective cohort study. Agri 2026;38(3):147-157. doi: 10.5606/agri.2026.74.