Interventional Management for Neck Pain Following Cervical Spinal Fusion: A Scoping Review

A subset of patients develop chronic neck pain after cervical spinal fusion without identifiable or correctable surgical pathology. Interventional procedures have been proposed, but evidence specific to interventional management of neck pain following cervical fusion has not been comprehensively synthesized. This scoping review aimed to map the evidence on interventional procedures (Concept) for persistent neck pain in adults after cervical spinal fusion (Population) in clinical settings (Context) and identify gaps in the literature.

A scoping review of MEDLINE, Embase, and CINAHL was conducted to March 2026 per PRISMA-ScR guidelines. The Population, Concept, and Context framework was used to determine inclusion criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, Newcastle-Ottawa Scale and Moga checklist. Findings were synthesized qualitatively and organized by intervention.

Thirteen studies met our inclusion criteria: 12 therapeutic studies (N = 532) across three intervention categories, and one prevalence study. Intervention categories included cervical epidural injection (CEI; one randomized controlled trial (RCT) with no placebo or sham, N = 116), facet-mediated interventions (FMIs; three studies, N = 219), and spinal cord stimulation (SCS; eight studies, N = 197). The CEI RCT reported 53-54% pain reduction, with responder rates at 69% and 71% at 24 months. FMIs showed 53% and 59% responder rates in two studies reporting outcomes in mixed populations. Reported SCS outcomes ranged from 25.7-82.5% across poorly controlled studies. Seven studies enrolled mixed cohorts with either confirmed post-fusion or cervical surgery patients, only providing indirect evidence. GRADE assessment was Moderate for CEI, Very Low for FMIs, and Very Low for SCS.

The evidence was predominantly of very low certainty. An exploratory evidence-informed clinical framework was developed. A lack of evidence was identified for posterior cervical fusion patients and stratified outcome reporting for post-fusion subgroups.