FAQs on Medial Branch Block in Houston

Medial branch block has emerged as the most-popular non-surgical method to relieve arthritis-linked pain in the neck and back. The minimally invasive procedure works by preventing pain sensation emanating from facet joints to reach the brain. It also helps reduce inflammation and irritation in these thumbnail-sized facet joints.

What is medial branch block?

Medial branch has tiny nerves that sprout from the spine and extend to facet joints. A medial branch block procedure involves injecting a combination of long-lasting steroid and anesthetic medication to these nerves.

Facet joints in the spine cause pain following tear down, arthritis, or degeneration of cartilages inside them and media nerves play a key role in communicating these pain sensations to the brain. The precise insertion of numbing and steroid medication disrupts the sensory communication to the targeted facet joint and stops the pain transmission and perception.

Why is a medial branch block performed?

Medial branch block is used for both facet syndrome diagnostic and pain management purpose. Facet joints between two vertebras get inflamed due to injury, arthritis, degenerative disorders, or any other chronic conditions. As result patients experience lower back pain that gradually radiates to thing and hip area and make standing or betting difficult. If facets joints in the neck area are affected, it may translate into pain neck, shoulders, and arm.

  • Diagnostic Use: Media block procedure is resorted to examine if the painful conditions affecting neck, mid, or low back are traced to facet joints in those areas. If patients feel the pain relief, doctors diagnose the problem as the facet syndrome. If not, they may go for other diagnostic methods.
  • Therapeutic Use: Facet surgeries do not assure good outcomes and conditions, such as arthritis, may actually worsen afterward. Again fusing facet arthritis at various levels through surgery entails greater risk of vertebra breakdown. Media block procedure, on the other hand, provides an alternative to surgery.

When Patients Require Medial Branch Block? What Conditions Are Treated Through Medial Branch Block?

  • Facet syndrome
  • Arthritis
  • Lower back pain
  • Neck spine pain
  • spinal stenosis
  • Spinal osteoarthritis

How Is Medial Branch Block Performed?

The procedure whether in the neck, mid-back, or low back is performed as an outpatient. Intravenous sedation is used only to make nervous patients relax, though it is not essential. Many doctors ask patients to have Valium oral pill 30 minutes prior to the block.

A patient is recommended to lie down on his or her stomach. The skin and soft tissues covering the targeted facet joint is numbed using a local anesthetic. Then a needle is inserted up to the medial branches surrounding the painful joint.

Doctors inject dye under fluoroscopis guidance to confirm whether the needle is perfectly placed. Anesthetic medication is inserted into it. Steroid medication may or may not accompany the numbing injection depending on the pain level.

What Is Injected During Medial Branch Block?

It is a subject of medical scrutiny whether numbing medication is enough or cortisone or similar steroids should be used in medial branch block injections. Researchers have acknowledged that significant pain relief these injections provide is not affected if anesthetic, such as lidocaine, is used alone or with steroid. However, if the pain is at a more intense level, steroid should be used so that inflammation and irritation in the medial branch can be minimized.

How Many Medial Branch Block Injections Should I Have?

Patients can repeat it the block procedure once the pain relief wears off, usually three to six months. A single medial branch block injection is found to bring down the facet joint pain by 50 percent over a period of five months.

To prolong the effects of medial branch block, patients may go for radiofrequency ablation follow-up procedure.

How Long Does It Take?

A single procedure takes around 30 minutes. You can go for a single block or multiple blocks subject to doctor’s approval. Doctors keep patients under their observation for another 30 minutes soon after the injection is administrated.

Do I Need Rest After Medial Branch Block?

Patients are free to drive home after a medial branch block. It is suggested that they take rest for the day and perform activities they are able to tolerate. Avoid putting stress on the targeted area. You can join your work if there is no complication except soreness at the injection site.

What Are The Side Effects of Medial Branch Block?

Injection site soreness and stiffness are the most common side effects that exist for a day or two. The pain may vanish immediately, but reappear once the numbing effect wears off. It again begins to subside leading to semi-permanent relief for months.

As there is no major side effect, patients not comfortable with invasive surgeries can go for it. However, misplaced needle or inept administration of injection may cause complications, including bleeding, injury to nerves, and infection.

Patients allergic to corticosteroids must inform about it to their doctors. These steroids may put them at the risk of temporary immune deficiency, stomach ulcer, high blood sugar, and increased arthritis pain.

How Well Does Medial Branch Block Work? What Are The Benefits of Medial Branch Block?

  • In 2007, Pain Physician journal reported a research report that recognized efficacy of medial branch block therapy for patients with chronic facet pain in lower back.
  • A practice guideline issued by the American Society of Interventional Pain Physicians and reported in the Pain Physician in 2007 suggested the procedure for its “accuracy in diagnosing lumbar and cervical facet joint pain.”
  • According to the Spine journal, high success rate makes medial branch block treatment increasing popular ever since it was used in 1994.
  • The Acta Orthopaedica Belgica reported findings of a 2007 study that highlighted 53% medial branch block pain relief over two months and 68% over six months.
  • There are also evidences to suggest that 80% cervical facet joint pain relief can be achieved using the procedure.

References

Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J. 2008;8:56-64

Finlayson RJ, et al. Cervical medial branch block: a novel technique using ultrasound guidance; Reg Anesth Pain Med. 2012 Mar-Apr;37(2):219-23

Manchikanti L, et al. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up.Spine (Phila Pa 1976). 2008 Aug 1;33(17):1813-20

Manchikanti L, et al; evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777

Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396

Anand S, Butt MS. Patients’ response to facet joint injection. Acta Orthop Belg. 2007 Apr;73(2):230-3

Boswell et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111