Temporary Peripheral Nerve Stimulation (PNS) of the Cervical Medial Branch Nerve (CMBN) for Chronic Axial Neck Pain-A Literature Review and Case Series

Abstract

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing literature and present a retrospective single-center case series of patients who underwent temporary PNS targeting the cervical medial branch nerves (CMBNs) for chronic axial neck pain. Methods: This investigation comprises a narrative literature review alongside a single-center, retrospective case series evaluating percutaneous, temporary PNS for the management of cervical spondylosis facet arthropathy in the absence of myelopathy or radiculopathy. The primary outcomes were pain reduction, as measured by the numeric rating scale, and improvements in functional disability, with assessments conducted at baseline and at 60 days post-intervention. Results: PNS represents a neuromodulatory, nondestructive intervention that targets the CMBN to alleviate chronic axial neck pain, in contrast to the destructive mechanisms inherent in cervical radiofrequency ablation (CRFA). Although PNS has been applied to other neural targets, its use in the cervical region is sparsely documented, with limited case studies available. Notably, this case series is the first to report pain and disability outcomes specifically associated with CMBN PNS. At the 60-day follow-up, 66% of subjects achieved the minimal clinically important difference (MCID) for pain reduction, while 77% met the MCID for disability reduction. Moreover, our analysis uniquely examined the impact of previous CRFA and a history of cervical spine surgery on treatment outcomes, revealing that patients with such interventions experienced more modest improvements compared to their surgery- and CRFA-naive counterparts. Conclusions: The current literature reveals a significant gap regarding the use of CMBN PNS, underscoring an unmet need in the treatment algorithm for chronic axial neck pain beyond conservative modalities. Our findings suggest that CMBN PNS may offer a promising adjunctive therapy for carefully selected patients with refractory chronic axial neck pain who have not improved after medications, physical therapy, or injections. Additionally, the comparative analysis of outcomes in patients with a history of CRFA or cervical surgery underscores potential advantages of PNS prior to destructive therapies. Future research, ideally in the form of prospective studies with larger cohorts and extended follow-up durations, is warranted to further evaluate long-term outcomes and refine the place of PNS in the treatment algorithm.

Keywords: cervical medial branch nerve; chronic neck pain; neuromodulation; peripheral nerve stimulation.

Figure 1

Changes in NRS and ODI comparing prior surgery and CRFA subjects with naive subjects. Yellow bar denotes the only findings that were statistically significant (p < 0.05).

Figure 2

Introducer needle positioned over the mid-cervical articular pillar at C3 under AP fluoroscopic view (red arrow). Image courtesy of Vinicius Tieppo Francio MD.

Figure 3

Lateral view confirming introducer needle position over the mid-cervical articular pillar at C3 (red arrow). Image courtesy of Vinicius Tieppo Francio MD.

Figure 4

Final lead position confirmed under AP fluoroscopy with distal electrode at the C3 articular pillar (red arrow). Image courtesy of Vinicius Tieppo Francio MD.

Figure 5

Lateral view of final lead deployment at the C3 articular pillar (red arrow).