Cervical facet nerve blockade improves head relocation accuracy for sagittal movements, shoulder joint relocation accuracy for shoulder abduction and standing balance in patients with chronic cervical pain

Abstract

To investigate whether unilateral cervical facet nerve blockade (FNB) is associated with changes in head repositioning accuracy (HRA), shoulder joint relocation accuracy (JRA), and standing balance in patients with chronic neck pain. This retrospective single-center interventional study included 99 patients treated at the Department of Physical Medicine and Rehabilitation. Cervical proprioception (HRA), shoulder proprioception (JRA), and standing balance (computerized posturography) were assessed before the intervention, immediately after FNB, and at 1-month follow-up. Because normal distribution could not be assumed, non-parametric tests were applied (Mann–Whitney U for independent comparisons and Wilcoxon signed-rank test for paired comparisons). Cervical proprioception during sagittal movements improved significantly after FNB, with effects maintained at 1-month follow-up. The most consistent improvement was observed for HRA during flexion ( p < 0.001). Shoulder JRA during abduction also improved significantly after FNB ( p = 0.002–0.02), and the improvement persisted at follow-up on the right side. Differences in JRA were observed between patients with upper versus lower cervical dysfunction, with lower cervical dysfunction showing a greater impact on shoulder relocation accuracy. Postural performance improved after FNB, particularly for trace length in the Romberg test ( p = 0.02–0.002), and improvements were sustained at follow-up. Patients with higher baseline postural sway demonstrated greater balance improvements than those with low baseline sway. Significant correlations were observed between postural performance and HRA/JRA measures. Secondary outcomes showed significant improvement at 1-month follow-up in neck pain ( p < 0.001), health-related quality of life (EQ-5D) ( p = 0.005), and disability (Oswestry Disability Index) (< 0.001). Unilateral cervical FNB was associated with improvements in cervical repositioning accuracy, shoulder abduction relocation accuracy, and postural performance, with effects persisting at 1-month follow-up. Improvements were also observed in pain, health-related quality of life, and disability. Given the retrospective single-arm design and single-center setting, these findings should be interpreted as preliminary and require confirmation in prospective controlled studies.