Medial Branch Block
Medial Branch Block Overview
A medial branch block (MBB) is a minimally invasive diagnostic procedure that can be used to diagnose facet mediated back and neck. Facet joints are in involved in carrying weight through your back/neck and allowing motion of the spine including flexion, extension and twisting. Facet mediated pain is often felt as a deep aching worse with movement. Facet joint pain can be caused from numerous factors including arthritis degenerative disc disease, falls and car accidents. Facet joints send pain signals through two medial branch nerves. Pain form the facet cannot be diagnosed by x-ray, CT scan, MRI, or Bone scan.
What is a Medial Branch Block?
An MBB is a minimally invasive diagnostic procedure that can temporarily relieve neck or back pain caused by facet joints. Using precision guidance a small amount of local anesthesia is placed directly on each medial branch. If the pain is coming from the suspected facet joints the pain should decrease by blocking each branch nerve. Generally, the MBB is effective for between 3-8 hours. If your pain is relieved 70% or more by the injection you may benefit form Radiofrequency Ablation, for longer-term pain relief. If the relief is less than this amount, you may have another significant spine disease that should be addressed with other therapies.
Prior to the procedure
Patients who take blood thinner medication (Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, high-dose aspirin) may need to stop taking their medications prior to the ESI. You must obtain approval from your prescribing physician prior to stopping any medication.
If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy X-rays are used during the procedure may be harmful to the fetus.
Sedation is rarely necessary or used, but If it is used you must take nothing by mouth for 4 hours prior to the procedure.
Day of the procedure:
- Plan to arrive 30 minutes before your scheduled appointment time.
- We recommend that you have something light to eat before the appointment.
- Make arrangements to have someone drive you to and from the office the day of the procedure.
- The procedure generally takes 15-30 minutes followed by a recovery period.
Step 1: Prepare the patient
The patient lays face down on the table, the skin is cleaned and the skin is numbed with a local anesthetic.
Step 2: Insert the needle
With the aid of a fluoroscope (a special X-ray), the doctor directs a needle through the skin to the area of the facet joints. Fluoroscopy allows the doctor to inject contrast and ensure correct placement of the needle.
Step 3: Inject the medication
When the needle is in place, the medications are delivered on to each facet joint. The needle is then removed.
Step 4: Recovery
Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the office or suite. Someone must drive you home.
After the procedure
Typically patients resume full activity the same day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol). The patient may resume taking all medications immediately after the procedure.
You will be given a Post procedure pain diary to record your response to the MBB over the first few hours.
What are the results?
Generally, MBB will provide 3-8 hours of relief and depending on your response you may be a candidate for a longer lasting procedure such as a Radiofrequency Ablation.
What are the risks?
As with any procedure, there are both potential risks and benefits. MBB is generally safe and serious complications are rare especially when using proper safety techniques such as fluoroscopy. The potential risks associated with this procedure include anaphylaxis, headaches, spinal headache from a dural puncture, bleeding, infection, allergic reaction, elevated blood pressure, nerve damage/paralysis (rare) and death. Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings, insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 3-8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).
MBB should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.