Medial Branch Nerve Blocks

Medial branch nerves play a key role in transmitting pain signals from the facet joints to the brain. These small nerves are connected to the facet joints, which are essential for spinal stability and mobility. However, when the facet joints become inflamed or irritated due to conditions like arthritis, injury, or degeneration, they can cause persistent pain in the cervical, thoracic, or lumbar spine. This type of pain can significantly impact daily activities, but targeted treatments such as nerve blocks or radiofrequency ablation can help manage and relieve discomfort effectively.

What Is a Diagnostic Medial Branch Nerve Block?

A diagnostic medial branch nerve block is a minimally invasive procedure used to identify whether the medial branch nerves are responsible for a patient’s neck or back pain. These small nerves transmit pain signals from the facet joints to the brain. During the diagnostic procedure, a local anesthetic is injected near the medial branch nerves to temporarily numb them. If the patient experiences immediate pain relief, it confirms that the facet joints are the source of discomfort.

This diagnostic test is an essential step in developing an effective treatment plan. If the nerve block successfully reduces pain, doctors may recommend a longer-lasting solution such as radiofrequency ablation (RFA) to provide extended relief by disrupting pain signals from the affected nerves. It should be noted that insurance companies typically require 2 successful diagnostic medial branch blocks before they will approve the radiofrequency ablation (burning the nerves) which is the treatment.

What Conditions Can Be Treated with Medial Branch Nerve Block?

Some of the conditions that can be treated with a medial branch nerve block includes:

Facet Joint Arthritis (Facet Syndrome)

Inflammation and degeneration of the facet joints due to aging or wear and tear.

Spondylosis

Age-related degeneration of the spine that leads to stiffness and pain.

Spinal Injuries

Trauma or whiplash injuries that affect the facet joints and surrounding nerves.

Chronic Back Pain

Particularly in the lower back (lumbar region) when conservative treatments have not provided relief.

Post-Surgical Spine Pain

Persistent pain following spinal surgery due to irritation or inflammation in the facet joints.

Post-Laminectomy Syndrome

Persistent pain after spinal surgery, often linked to facet joint irritation.

What to Expect During the Medial Branch Nerve Block Procedure

Preparation: Before the Procedure

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Medical Evaluation

Your doctor will perform a comprehensive history and physical exam, which may include imaging tests such as X-rays or MRIs, to confirm the diagnosis and plan the procedure.

Medications

Inform your physician about any medications or supplements you are taking, as certain medications, like blood thinners, may need to be paused before the procedure.

Fasting

As you will be lying face down for the procedure we recommend that you refrain from eating for several hours beforehand.

Clothing & Transportation

Wear loose, comfortable clothing and arrange for someone to drive you home after the procedure.

Consent & Instructions

You will review and sign a consent form and receive detailed guidance on what to expect before, during, and after the procedure.

During the procedure

The procedure usually lasts 10-15 minutes, depending on the number of joints being treated.

Sterile Preparation

The area for injection will be thoroughly cleaned with antiseptic solution to prepare a sterile field for the procedure. The physician will wear sterile gloves for the duration of the procedure.

Anesthesia

Local anesthesia such as Lidocaine will be injected to numb the area (similar to the numbing you would receive at the dentist) to ensure comfort during the procedure.

Positioning

You will lie on your stomach on a specially designed table, allowing the doctor easy access to your spine.

Guided Injection

Using fluoroscopic (real-time X-ray) guidance, the doctor carefully positions a thin needle near the medial branch nerves to ensure precise medication delivery

Injection

A small amount of local anesthetic is injected to numb the medial branch nerves, providing quick but temporary pain relief.

Bandage

After the injection is complete, the area is cleaned, and a bandage is applied to protect the site.

After the Procedure: Post-Care

Monitoring

You will rest in a recovery area while your vital signs are monitored for about 15 minutes.

Pain Relief

Many patients experience immediate or significant pain relief. Mild discomfort at the injection site is normal and should subside within a few days. You’ll be asked to track your pain levels for several hours and up to a day after the injection.

Activity Restrictions

Avoid heavy lifting, bending, or strenuous activities for the first week. However, light walking and routine daily activities are encouraged to aid recovery.

Follow-Up

A follow-up appointment will be scheduled to review the results of the diagnostic block and discuss the next steps for long-term pain relief.

Risks and Side Effects

A medial branch nerve block is a generally safe procedure, but like any medical intervention, it carries some potential risks and side effects. Common side effects include temporary soreness, mild bruising, or swelling at the injection site, which typically resolves within a few days. Some patients may also experience temporary numbness or muscle weakness in the treated area due to the anesthetic. In rare cases, an allergic reaction to the anesthetic or contrast dye used during the procedure may occur.

If any severe side effects arise, patients should contact their doctor immediately for further evaluation and guidance. It can be discussed during your consultation appointment.