Chronic neck and back pain are debilitating conditions that affect millions of people every year. When a course of rest, non-steroidal anti-inflammatory medicine, and other lifestyle pain management treatments doesn’t work, doctors and patients look to other therapies for help. Medial branch blocks are a way to not only manage chronic neck or back pain but to also diagnose it. What is a medial branch block and how does it work?
What is a medial branch block?
Medial branch blocks are minimally-invasive spinal injections. That’s the short answer. They are similar to other types of spinal injections in that they often use a numbing medicine along with an anti-inflammatory medicine to control both pain and inflammation. This procedure is typically performed in an outpatient capacity and is considered a non-invasive alternative to surgery with few side effects.
Medial branch blocks differ from other types of spinal injections in that they are also used as a diagnostic tool. This is related to how and where the injection is delivered and can be a valuable pain-relieving tool.
Injury or trauma on facet joints in the neck and back may account for 45% of pain experienced by adults in the United States. It is important that specialists understand how to treat this pain effectively and quickly to restore balance to the lives of their patients. Medial branch blocks offer a minimally-invasive option for pain specialists to do so.
Anatomy of medial branch blocks
To understand how medial branch blocks can serve as diagnostic tools, it is important to know a little bit about anatomy. Facet joints are the joints located between the vertebrae. They are also on each side of the cervical vertebrae and along the ridges of the lumbar spine. These joints are lubricated and cushioned with synovial fluid. This fluid allows the bones to slide smoothly across each other. To make movement more comfortable, each facet joint is also surrounded by a thin layer of cartilage.
The vertebrae, including the facet joints, surround the delicate nerves of the spinal cord. The medial branch nerves come out of the facet joints. These nerves are responsible for sending signals to the brain.
When any part of this joint – the joint itself, the synovial fluid, or the cartilage – becomes damaged or begins to deteriorate, pain and inflammation can result. As deterioration continues, the medial branch nerves send signals of pain to the brain. Increasing pain and decreased range of motion are very common as joints continue to decline.
Watch the procedure — a medial branch block video
Medial branch blocks are injections delivered directly into the facet joint. Patients lie face down on a table. The area to be injected is cleaned and sterilized. Guided by fluoroscopy, the pain management specialist will inject the spine with a local anesthetic (e.g. lidocaine) and a steroid (if using).
To avoid pain during the procedure, a local anesthetic will be injected to numb the area around the block. This will involve a small needle and you may feel a prick and a burning sensation before the medication begins working, however, there is normally little pain associated with the procedure. Some patients may request sedation if they are anxious about the procedure, but in general patients receive only a local anesthetic.
The procedure itself only takes a few minutes but patients should plan for an hour for the pre-procedure prep and recovery observation for a short period of time after the injection. If you do choose to use a sedative the appointment will take longer and you will need to make sure you have a driver and caretaker once you are home.
Patients will rest briefly after the procedure and can continue with their normal activity shortly afterwards. This recovery time will vary, depending on whether or not sedation was used. In general, most patients are able to return to full activity w