A Medial branch block is a procedure that helps to diagnose and relieve back and neck pain from degenerative and painful facet joints. There is a pair of facet joints at each vertebral level which allow movement of the spine and provide stability. The joint has a capsule like a finger joint has and can be affected by arthritis and degenerative changes. The medial branch is a nerve that carries pain signals from the facet joint to the spinal cord and brain. Medial branches are located along the part of the vertebra that is next to the joint. Each joint gives pain signals to the medial branch above and below the joint. Therefore, 2 medial branches should be blocked to stop pain signals from 1 joint.
How Does it Work?
A local anesthetic medication (like novacaine) is injected over 2 medial branches to block the pain signals from 1 joint. If there is pain relief, it suggests that the anesthetized joint is the source of pain. If there is no pain relief, it suggests that there may be a different pain generator accounting for the neck or back pain.
How Is It Done?
Under X-ray (fluoroscopic) guidance, a needle is directed to the medial branch that lies along the vertebral bone, next to the facet joint. A small amount of X-ray dye is injected to confirm proper placement. A local anesthetic is then injected. This feels like a pressure or “fullness” in the neck or back. The needle is then removed and the patient is taken to the recovery area.
What Are The Risks?
As with any invasive procedure, there are some risks and complications associated with medial branch blocks. Anytime a needle is put into the body, there is a risk of infection, bleeding and allergic reaction. The risk of infection is prevented by using sterile techniques. The risk of bleeding is very minimal if patients are not on any blood thinners. There are very few allergic reactions to the medications that are used for the injection. If any allergic reactions are identified, medications will be given and patients will be observed to prevent any serious complications.
What Can I Expect After?
Most patients feel some immediate relief from medial branch blocks. Patients usually go home about 20-30 minutes after the injection. Patients are asked to complete a pain history for the rest of the day to help determine if the injections provide relief. Patients are advised to rest on the day of the injection, but may return to normal activities the next day. Patients will often be instructed to make a follow-up appointment after the injection.