What Are Medial Branch Blocks?
by Nicole Berardoni M.D., Paul Lynch M.D., and Tory McJunkin M.D.
Medial branch blocks (MBBs) are a minimally-invasive, non-surgical treatment that are used for arthritis-related neck and back pain. This pain management technique works by reducing the inflammation and irritation in the facet joints of the spine that is causing your pain. An exciting aspect of this pain relief modality is that, if it successful, a more long-term treatment option called radiofrequency ablation of the medial branch can be employed.
BL-Medial-Branch-Block-8The facet is a joint that connects one vertebra (bone of the spine) to another. The needle is placed over the nerve that provides sensation to the facet joint.
This nerve is the medial branch. The injection includes both a long-lasting steroid and a local anesthetic like lidocaine. The steroid reduces inflammation and irritation, and the anesthetic works to numb the pain. The entire procedure usually takes less than 15 minutes.
BL-Medial-Branch-Block-7The greatest success achieved with the use of medial branch blocks is the rapid relief of symptoms. With pain relief, patients are able to resume their normal daily activities, which is often not achieved with oral medications and physical therapy. Another benefit to the use of the MBB is its use as a diagnostic test to see if pain is coming from the joint itself.
BL-Medial-Branch-Block-6If your pain disappears with the injection, then it is clear that the pain originates from the joint.
Therapeutic lumbar MBBs with local anesthetic and steroids may be effective in the treatment of chronic low back pain of facet joint origin (Manchikanti 2007). The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain. This guideline explains that the facet joint nerve blocks or MBBs are strong in their accuracy of diagnosing lumbar and cervical facet joint pain (Boswell 2007).
Risks of Medial Branch Blocks
Medial-Branch-Block-1With minimal risks, MBBs are considered an appropriate and safe non-surgical treatment for many patients who suffer from back and neck pain. The associated risks with this procedure involve misplacement of the needle. In order to prevent this problem, doctors at Arizona Pain Specialists use fluoroscopy to guide their needle.
Potential complications associated with the procedure include bleeding, infection, and nerve damage. The other risks of the MBBs may be directly related to the medication injected.
The risks of developing medication side effects are typically much less than in a person taking oral corticosteroids. Some of the potential side effects of corticosteroids include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system. Before receiving a facet injection patients should be assessed by their physician to minimize risks associated with the procedure.
Medial-Branch-Block-3MBBs have increased dramatically in the Medicare population from 1994 to 2001 and are becoming even more popular today (Friedly 2007). They are being used more frequently because they have provided successful results in the treatment of back pain. A recent study looked at patients with back pain who received MBBs. At eight weeks of treatment 53% of people reported improvement of their pain and by six months of treatment over 68% reported the same (Anand 2007). The duration of pain relief varies for each individual but if the first MBBs provide relief, then the procedure can be repeated or facet denervation can be done.