Medical Branch Block

What is a Medial Branch?

Nerves called “medial branches” supply facet Joints.  These nerves relay pain signals to the spinal cord and those signals eventually reach the brain. That is when you notice the pain.

What is the purpose of it?

If the nerves are “blocked”, they will no longer be able to carry pain sensation to the spinal cord.  It is like temporarily cutting off “wires”. If, the pain is due to facet joint arthritis or some type of injury, you should feel relief from pain and stiffness.Once it is established that the pain is due to facet joint disease, a procedure called “Rhizotomy” can be done to prevent the conduction of pain for several weeks months or years. Therefore a medial branch block is considered a temporary and diagnostic procedure.

How long does the injection take?

The actual injection takes only a few minutes. The more nerves that need to be blocked, the more time it takes.

Will the injection hurt?

The procedure involves inserting a needle through the skin and deeper tissue.  Therefore, there may be some discomfort involved. We do numb the skin and deeper tissue with a local anesthetic (lidocaine) using a very thin needle.   Once the local has been given, the needle is inserted into the joint.

Will I be “put out” for this procedure?

This procedure is done under local anesthesia.  Many patients also receive intravenous sedation and pain medication, which makes the procedure easier to tolerate.  The amount of sedation given generally depends upon the patient’s individual needs and tolerance to the procedure.

How is the procedure done?

The patient lies on their stomach, and the procedure is done under x-ray control (live x-ray). Patients are monitored with a cardiac monitor (EKG), blood pressure cuff and blood oxygen-monitoring device.  The skin on your back is cleaned with antiseptic solution, and the area is covered using sterile drapes. Then the injection is done.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain is gone or much less. This is due to the local anesthetic. This may last only for a few hours.  Your pain most likely will return and you may have a “sore back or neck” for a day or two.  This is from the needle insertion.  It is very important for you to keep track of your pain and stiffness for the next 2-8 hours following injections.  Your response to the injections will establish if the facets are the cause of your pain.

What should I do after the procedure?

You need to have a ride home.  We advise you to take it easy for a day or so after the procedure.  It is recommended that you apply ice to the affected area.  Perform your normal daily activities as tolerated. *You will get a “pain chart” to fill out for the next 8 hours. You will need to chart your level of pain (0-10) from the time the procedure is completed until the 8th hour.  It is advised that you keep this chart for follow up visits with your physician.

When can I go back to work?

You should be able to return to your work the next day. Your physician will advise you if there are any restrictions. The most common thing you may feel is soreness in the area where the injection was done.

How long will the block last?

The immediate effect is from the local anesthetic injected.  Sometimes relief can last from 2 hours to 8 hours.  But, if the facet joints are not the cause of your pain, you may not have much relief.

How many injections do I need to have?

Usually one procedure is enough to determine if the facet joints are the most likely source of your pain.  However, a “placebo effect” can be as high as 30-40%. It may recommend to some patients that they have repeated diagnostic injections. 

Will the procedure help me?

If the pain is coming from the facet joints, you should benefit from this procedure on a temporary basis.  Some do get a “placebo effect” and others may get a “False-Positive” response.  But remember that these are DIAGNOSTIC INJECTIONS only and will only last for a few hours.  These are done to verify if the pain is coming from the facet joints. We will recommend a procedure called a“Rhizotomy”if you get a good response to the Medial Branch Block. This procedure will “numb” the same nerves for many weeks to months or longer.

What are the risks and side effects?

The procedure is safe.  But, with any procedure there are risks, side effects, and the possibility of complications.  The most common side effect is pain – which is temporary.  The other risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc.  Fortunately, the serious side effects and complications are rare. Your Doctor will review the risks and side effects with you.

Who should not have this injection?

If you are allergic to any of the medications to be injected, or if you are on a blood thinning medication (i.e. Plavix, Coumadin, daily aspirin, aspirin containing medication, medications such as Motrin or Advil), or other anti-inflammatory, Patients with bleeding disorders (Hemophilia, thrombocytopoenia, or any other coagulopathies), or if you have an active infection going on, you should not have the injection.  Be aware that herbs Ginseng, Garlic and Gingko Baloba and Vitamin E are blood thinning.

* DO NOT STOP ANY OF YOUR MEDICATIONS BEFORE CONSULTING WITH YOUR DOCTOR*