Medial Branch Blocks

What is a Medial Branch?

Facet Joints are innervated or "supplied" by nerves called "medial branches". These nerves carry the pain signals to the spinal cord and the signals eventually reach the brain, where the pain is noticed.

What is the purpose of it?

If the nerves are "blocked" or "numbed", they will not be able to carry pain sensation to the spinal cord. It is like temporarily cutting off "wires". Therefore, if the pain is due to facet joint arthritis, you should have relief from pain and stiffness. Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called "Radio-Frequency Ablation" and prevent the conduction of pain information for several weeks to months. So, in a way, medial branch block is a temporary and diagnostic procedure.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

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

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine).

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). Therefore, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

How is the injection performed?

It is done either with the patient lying on the stomach for the upper and low back pain, or for the cervical (neck area) injections, in sitting position or lying on the back, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This may last only for a few hours. Your pain will return and you may have a “sore back or neck” for a day or two. This is due to the mechanical process of needle insertion. It is very important for you to keep a track of your pain and stiffness for the next two to 12 hours following injections. Your response to the injections will determine if the facets are the cause of your pain or not.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform your usual activities as tolerated.

Can I go to work to work the next day?

You should be able to return to your work on the next day.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®), or if you have an active infection going on, you should not have the injection.

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