MEDICAL BRANCH BLOCK

Indications

Conditions that are well suited for this treatment are the same ones that can be treated by cervical/lumbar medial branch nerve rhizotomy. These include neck or back pain that is non-radicular, motion sensitive, or associative with facet joint types of pain sources. Cervicalgia, lumbago, degenerative joint pain, spondylosis, neck or back injury, and some whiplash injuries are all treated with medial branch blocks and later facet radiofrequency rhizotomy if indicated.

This procedure is indicated for mostly non-radicular pain. Medial branch nerves are involved in pain coming from the facet joint. This pain can include facet arthropathy, facet joint or disc degeneration and facet joint syndrome. The same nerves are then indicated for the rhizotomy procedure to prolong the pain relief. The area ‘burned’ is usually around 10 mm and the nerve can grow back with pain recurring after a prolonged period of pain relief.

What to expect

Patients usually have injections of the medial branch nerves done on an outpatient basis using fluoroscopy or other image guidance for proper needle placement. Because the nerves give off branches both above and below the joint, there usually are three or four needles used to block all the contributing nerves of the suspected levels. The skin will be numbed and the needles placed with sometimes small amounts of contrast used to confirm placement. Then a solution of steroid or local anesthetic is injected in small quantities. The effects of the local anesthetic will wear off before the steroid takes full effect such that the immediate effects of the anesthesia may wear off and the pain recur before the longer lasting impact of the steroid.