A medial branch block is an outpatient, minimally-invasive procedure used for the treatment of neck, back, buttock, him, groin, and leg pain. This procedure involves injecting the nerves that supply the tiny facet joints along the posterior region of the spine.
What are the facet joints?
Located on both sides of the spine, and between two vertebrae, the tiny facet joints guide the spine in movement. Facet joint pain occurs from damage to the joint, loss of joint cartilage, or problems with the structures around the joint. The pain of an injured facet joint can range from mild muscle tension to severe stabbing and burning pain.
How common is facet joint pain?
According to clinical studies, lumbar facet joints are the source of chronic back pain in around 30% of patients with this complaint.
How do I prepare for the medial branch block procedure?
First, you will meet with the pain management specialist to discuss your condition and symptoms. The doctor may order/conduct some additional diagnostic tests. You cannot have the procedure if you have an active infection, are taking anticoagulants for a heart condition or bleeding disorder, or have allergies to certain medications/solutions used during the procedure. The doctor will ask questions to assess your candidacy. In addition, the doctor reviews the procedure risks and benefits and has you sign a consent form.
What happens during the medial branch block?
Once you are positioned face-down on the procedure table, a nurse will administer a sedative into your IV line. The back is cleaned with an antiseptic solution, and the Phoenix pain management doctor numbs the region using a local anesthetic. Fluoroscopic x-ray guidance is used to ensure safe and proper needle position near the medial branch nerve being targeted. After the medication is instilled (alcohol, phenol, bupivacaine, or lidocaine), the needle is removed, and a band-aid is applied.
What can I expect after the medial branch block injection?
Right after the procedure, you are monitored by a recovery nurse for 30-60 minutes. You must keep track of your pain and alert the nurse of how you are feeling. Expect immediate pain relief due to the anesthetic, but the pain may gradually return. If the medial branch block works, the doctor may suggest a radiofrequency ablation (RFA) procedure to destroy a portion of the medial branch nerve root. Expect some tenderness at the injection site. In addition, you cannot drive or do rigorous activities for 24 hours. We recommend you wait 2-3 days before returning to usual duties.
Why inject the medial branch nerves?
The medial branch block is often used to diagnose nerve-related pain from disease or injury to the facet spine joints. Injecting these medial branches is a definitive way to diagnose facet joint syndrome. In addition, blocking the nerves relieves persistent nerve-related pain.
Is the medial branch block effective?
The medial branch block was evaluated in a double-blind, randomized controlled trial. Patients with chronic low back pain from the facet joints were given this block. Of the 120 subjects, 60 were given a block using only an anesthetic (group 1), and 60 were given a block with a corticosteroid and anesthetic combination (group 2). Researchers found that the block had a 90% success rate for group 2, and an 85% success rate for group 1.
The expert pain management doctors in Phoenix at Pain and Spine Clinics offer medial branch blocks, radiofrequency ablation and all kinds of interventional procedures to help relieve a patients’ pain nonoperatively. Most insurance is accepted, call us today!
Manchikanti L, Singh V, Falco FJE, et al. (2010). Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up. Int J Med Sci, 7(3), 124-135.