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Medial Branch Block

A medial branch block tests whether or not the medial branch nerves in your neck, mid-back, or lower back are causing your pain. These medial branch nerves branch from the spinal onto the facet joints. These joints provide stability to the spine and allow you to bend, flex, and twist your spine. 

A medial branch nerve block is a procedure in which an anesthetic or numbing agent is injected near these nerves. Medial branch blocks are applied to three areas: cervical (your neck), thoracic (mid-back), and lumbar (lower spine from your hips to your tailbone). 

Facet joint pain, which comes from the medial branch nerves, can result in symptoms of achiness, muscle tension, and pain that worsens when moving spinal joints through their range of motion. More specifically, cervical facet joint pain affects the first seven vertebrae of your back. Pain from these joints may result in pain in the neck, head, upper back, and shoulders. You may also have radiating pain down the arms and shoulders along with increased pain when moving the neck side to side or by looking up.   

Thoracic facet joint pain affects the twelve vertebrae beneath your shoulders and above your hips. Those who have issues in their thoracic joints mostly feel pain in their mid-back. Lumbar pain affects the last five vertebrae of the spine and the tailbone. Lumbar joint issues result in an achiness in the lower back with the possibility of radiating pain down the legs. Also, standing upright and bending backward may worsen your pain. 

Trauma to the back from a car accident, whiplash injuries, slip and fall, or other injuries along with spinal stenosis and osteoarthritis can lead to inflammation in the facet joints. This inflammation causes the nearby medial branch nerves to release pain signals. 

How Do I Prepare for a Medial Branch Block? 

You will need to bring a responsible adult with you to your appointment. You will be unable to drive 24 hours after receiving a medial branch block. Furthermore, you cannot take public transportation such as the bus or a taxi unless you have a responsible adult accompanying you. 

Prior to your appointment, you will need to stop taking anti-inflammatory medications such as Advil, Aleve, ibuprofen, and any prescribed anti-inflammatories 3 days before the branch block. Take your other medications as normal. If you have any questions regarding which medications you can and cannot take, contact your pain clinic prior to your appointment. If your regular physician has prescribed you an anti-inflammatory, you must receive authorization to discontinue the medication for the block prior to setting an appointment. 

The Procedure

Expect to spend about an hour and a half at the pain clinic. You will need to arrive 30 minutes prior to your appointment to take a valium. Valium will help relax your muscles and reduce anxiety. Prior to the injection, you will have your vitals taken by the nurse and they will explain the procedure and go through paperwork with you. Depending on the area, you may need to change into a designated gown for the procedure. Otherwise, the nurse will guide you back to the injection room. 

Cervical

Wear comfortable clothing for the procedure. You’ll lay on your side on top of an x-ray table. Your shirt may be taped to your shoulder to increase access to the injection location. The injection site will be cleaned and sterilized. Then the injections will begin, starting with the numbing medication. After the numbing medication has been applied, a contrast dye will be injected to verify the needles are properly placed for the anesthetic. Once the anesthetic has been applied, the area will be cleaned and you’ll flip onto your other side for the second set of injections repeating this process. After the injections have been completed, you may feel unbalanced as cervical injections can affect your balance receptors.

Thoracic

Thoracic medial branch procedures begin with you lying face down on the x-ray table. You’ll be provided with an open-back shirt for the procedure. The pain technician will clean the injection site and apply numbing medication. Then contrast dye will be injected into the area and viewed using fluoroscopy which is a type of x-ray imaging. Once the pain technician has confirmed the position of the needles, they will inject the anesthetic. 

Lumbar

Lumbar medial branch blocks begin with you lying face down on an x-ray table. You’ll be provided with a gown for the procedure. The pain technician will clean the injection site and begin the procedure. 

After the Injection

You must stay awake for the first four hours following your injection to track pain relief. Thus, IV sedation typically isn’t offered for a medial branch block but remains a possibility for the radiofrequency ablation procedure. If the facet joints are the source of your back pain, it’s likely you’ll experience relief from pain soon after the procedure. However, because medial branch blocks are a diagnostic testing tool, the pain relief will be temporary. 

After the procedure, you should try to gently reproduce your pain by doing activities that normally would increase your pain. This will help test how much relief the injection gave. At your follow-up appointment, you will report back on how much relief you experienced. 

For the first two days after your injection, you should avoid bathing or submerging your body in water. Typically, a follow-up appointment will be scheduled about two weeks after the procedure to decide what next steps to take in your treatment plan based on your pain relief. Your doctor may recommend radiofrequency ablation (RFA) treatment for long-term pain relief. 

Risks/Side Effects

Most injections carry a risk of bleeding or infection. Short-term side effects might include numbness, pain or tenderness at the injection site, headaches, or insomnia. An allergic reaction to the anesthetic or contrast dye may also occur. Be sure to inform your doctor of any known allergies prior to the injection.

Who Should not Have a Medial Branch Block?

Those who have any of the following:
  • An Active Infection
  • Fever
  • Night Sweats
  • Antibiotic Prescriptions
  • A Pacemaker or Defibrillator  

Additionally, anyone who has a dental or colonoscopy procedure 48 hours before or after a medial branch block appointment should reschedule their procedure. 

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