Objective: Cervical facet joints are prominent sources of chronic neck pain. This single-center retrospective cohort study compared ultrasound (US)-guided and fluoroscopy (FL)-guided cervical medial branch procedures at the C3–C6 levels in terms of technical success and tested for non-inferiority (NI). Methods: Between March 2022 and July 2025, 224 procedures performed at the Adana City Training and Research Hospital, Department of Algology (US, n = 104; FL, n = 120), were analyzed. The primary endpoint was technical success. Secondary endpoints included procedure duration; complications; pain intensity, measured using the Visual Analog Scale (VAS); functional outcomes, assessed with the Neck Disability Index (NDI) at 1, 3, 6, and 12 months; and radiation exposure in the FL group. Propensity score weighting was applied to reduce confounding. The NI margin for technical success was set at −5 percentage points, with α = 0.025. Results: The technical success rates were similar (US: 90.4%, FL: 90.8%; difference: −0.4%, 95% CI: −8.1 to 7.2), but non-inferiority was not statistically achieved (power ≈ 72%). Procedure time was significantly shorter in the ultrasound-guided group compared with the fluoroscopy-guided group (mean difference −5.2 min; 95% CI: −7.5 to −2.9; p 0.05). Similarly, functional outcomes (NDI) did not differ significantly between the ultrasound- and fluoroscopy-guided groups throughout follow-up (all p > 0.05). Exploratory analyses using minimum clinically important difference (MCID) thresholds supported the clinical non-inferiority of US. In the FL group, the mean fluoroscopy time was 2.28 min with low radiation doses. Conclusions: Although NI was not statistically confirmed for technical success, US achieved comparable outcomes to FL with shorter procedure times and without radiation exposure. Both modalities provided similar long-term pain relief and functional improvement. US can be considered a safe and effective alternative in experienced hands, but larger multicenter prospective NI trials are needed to confirm these findings.
Kucukbingoz et al. (Mon,) studied this question.