Oluwatobi O Onafowokan, Nicola F. Fine, Francis Brooks, Oliver M. Stokes, Timothy WR Briggs, Mike Hutton

March 2020, Volume 29, Issue 3, pp 564 - 578 Review Article Read Full Article 10.1007/s00586-019-06258-w

First Online: 01 January 2020

Multiple injections for low back pain: What's the future?


To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data.


Systematic review using patient, intervention, comparison, outcome and study strategy. The literature search using Cochrane, MEDLINE and EMBASE databases using MeSH terms: lumbar spine, spinal injection and facet joint (“Appendix A”).


Three studies were identified that investigated the efficacy of multiple FJIs or MBBs. None of these studies reported sustained positive outcomes at long-term follow-up.


There is a paucity of levels I and II evidence available for the efficacy of multiple FJIs and MBBs in treating low back pain. GIRFT data show a high degree of variation in the use of multiple FJIs, which would not be supported by the literature.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[graphic not available: see fulltext]

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