FAQ’s on Medial Branch Nerve Block in Las Vegas

A medial branch block is a simple procedure done to relieve the pain associated with spinal arthritis or facet joint syndrome. This procedure is safe, effective, and minimally invasive.

What are facet joints?

The tiny joints located in the posterior region of the spine are called facet joints. These joints prevent bending and twisting of the lower back, and are easily damaged. Injury occurs to the facet joints from falls, car accidents, aging, arthritis, repetitive lifting, and loss of disc height.

What is the cause of facet joint syndrome and spinal arthritis?

The facet joints carry approximately 15% of the total body weight. However, when the space between two discs narrows, the weight load is increased to around 65%. Further damage occurs to the facet joint lining and cartilage, bone spurs develop, and tears occur in the outer layer of the discs. A medial branch block is used to diagnose damage and injury to the spinal column, and it can alleviate the pain associated with nerve compression (radiculopathy).

What should I do before the medial branch block?

Before your procedure, the doctor will go over your medications and ask you to hold blood-thinning agents for several days. Do not eat or drink after midnight, and bring someone to drive you home. Once you arrive at the medical center, a nurse goes over the procedure and asks you to sign an informed consent paper. After you change into a gown, the nurse starts an IV line in your arm and connects monitoring devices to assess vital signs.

What should I expect during the medial branch block procedure?

In the procedure room, you are positioned on your stomach with pillows under your pelvis for support. Once the skin over the painful area is cleansed with a special solution, the skin is numbed with a long-acting anesthetic. A needle is guided through the facet joint using real-time x-ray, and an anesthetic is instilled onto the nerves. The doctor may use a neurolytic agent to destroy a portion of the nerve root, such as absolute alcohol or phenol. When the needle is removed, a dry bandage is applied.

What should I expect after the procedure?

Mild tenderness and soreness at the site of injection is expected after the medial branch block. A nurse will monitor your condition for about 30 minutes. Use ice on the lower back for pain relief, avoid soaking in a hot tub or pool for a few days, and do not return to usual activities for a couple days.

Does the medial branch block hurt?

A mild sedative is used during the procedure, but you may experience some mild pain. The local anesthetic feels like a slight pinch and mild burning, and pressure is felt when the medication is instilled onto the nerves.

What complications and risks are associated with the medial branch block?

Expect to experience some slight soreness at the injection site, which will resolve in 1-2 days. The risks associated with this procedure include bleeding, nerve damage, blood vessel injury, and infection.

Is the medial branch block useful for diagnosing back pain and treating spinal arthritis?

A recent research study shows that the medial branch block has a 70% success rate, and pain relief last for 3-6 months. Based on one recent clinical study, when radiofrequency neurotomy was performed with the block, the procedure was 85% effective.

Resources

Derby R, Melnik I, Choi J, & Lee JE (2013). Indications for repeat diagnostic medial branch nerve blocks following a failed first medial branch nerve block. Pain Physician, 16: 479-488.

Roy, C., Chatterjee, N., Ganguly, S., & Sengupta, R. (2012). Efficacy of combined treatment with medial branch radiofrequency neurotomy and steroid block in lumbar facet joint arthropathy. Journal of Vascular Interval Radiology, 23(12), 1659-1664.

Son JH, Kim SD, Kim SH et al. (2010). The Efficacy of Repeated Radiofrequency Medial Branch Neurotomy for Lumbar Facet Syndrome. J Korean Neurosurg, 48(3): 240-243.