10 Important Facts About a Medial Branch Block


Medial Branch BlockSometimes the only way combat pain in the lower back is to take extreme measures. Depending on the kind of back pain you’re experiencing your doctor may recommend one of several different treatment options. So what does it mean if you have facet syndrome or they suggest a medial branch block? Find out all you need to know about this non-surgical treatment.

1. Understanding Back and Spine Anatomy

As with any medical treatment it can be quite easy to get lost in translation as your doctor describes how your spine and nerves are connected and what may be causing the pain. A medial branch block involves injecting local anesthetic into the medial branch nerves which connect to facet joints. Facet joints are small bone projection from vertebra on both sides of the spine that connect with the joints on adjacent vertebra. These joints can become inflamed over time and cause facet joint pain. When this happens the medial branch nerves send pain signals to the brain. The injected anesthetic prevents these nerves from transmitting the painful information to the brain offering momentary respite.

2. Just What Is Facet Syndrome?

Facet syndrome is the official name for pain that is caused by inflammation of the facet joints. It may also be referred to as osteoarthritis. Facet syndrome may occur on any point along the spine and is caused by the natural wearing-down of spinal discs due to aging. Lumbar facet joint pain may be felt in the lower back, buttocks and legs. Cervcal facet joint pain affects the upper back, neck and shoulders.

3. A Medial Branch Block is Step One of a Two-Step Diagnostic Process

While a medial branch block in itself seems like treatment in its own right it may be used to accurately determine if facet syndrome is the right diagnosis. If a patient reports being pain-free after a medial branch block it is determined that facet syndrome is the cause of pain and that the patient may be a candidate for a following procedure for longer lasting pain relief.

4. A Medial Branch Block is Temporary

Although a medial branch block is a non-surgical treatment option the pain will only last a few hours or days after the procedure. Since the reason for injecting anesthetic into the medial branch nerves is to diagnose facet syndrome you will need to keep track how long the pain is absent or reduced. If your back pain returns then a medial branch radiofrequency neurotomy may be considered for future treatment.

5. How is a Medial Branch Block Performed?

A medial branch block is an outpatient procedure that takes relatively short time to do. The actual injection itself takes only a few minutes but the time spent at the clinic may be about an hour or more. Sedation is not usually used during this procedure but may be necessary for relaxation. The patient lays on their stomach on the exam table and the area to be injected is cleansed and prepped. A numbing anesthetic is given followed by the injections into the medial branch nerves. X-ray guidance may be used to ensure that the anesthetic reaches the medial branch nerve.

6. What Happens After the Procedure?

After the procedure patients are monitored for thirty minutes in the recovery area. Your doctor may ask you to perform tasks that have caused pain in the past to make sure the anesthetic is doing its job. You may experience no pain or diminished pain. This means the medial branch block is working like it should. You may also be asked to keep a pain diary during the time after the procedure to accurately record results. Most patients may return to work and their normal activities by the next day or sooner with their doctor’s permission.

7. What Are the Risks and Complications?

As with any medical procedure there are bound to be some complications or risk factors. Fortunately a medial branch block has relatively few complications.

  • Allergic reactions, usually due to the contrast used to guide the procedure.
  • There is a minor risk of infection that occurs in less than 1-2% of medial branch block injections.
  • Pain or discomfort at the injection site.
  • Bleeding may occur in patients with underlying bleeding disorders.
  • Pain symptoms get worse after the procedure.
  • The chance of nerve, spinal cord damage or paralysis is extremely rare.

At the worst your back pain may not be affected at all meaning facet joint syndrome is not the source of pain.

8. Next Steps: Determining Long-Term Treatment Options

For some time after the medial branch block procedure you may experience less pain or no pain at all. Keeping track of this can help your doctor determine if you are a candidate for further procedures such as radiofrequency neurotomy where pain signals to the brain will be interrupted by a heat lesion created on the nerve without disrupting sensation and muscle strength.

9. Are There People who Shouldn’t Have a Medial Branch Block?

In some cases certain individuals may not be able to have a medial branch block. Patients should discuss with their doctor if they are allergic to any of the drugs being used in the procedure or if they are taking blood thinners like coumadin. Patients with bleeding and blood clotting disorders should also discuss this with their doctor prior to the procedure. Always discuss your medications with your doctor to determine if you will need to adjust dosages before the operation.

10. What If It Didn’t Work?

While a medial branch block has relatively few side effects and complications the worst is perhaps the possibility that it won’t have any affect at all on your back pain. This could mean that facet syndrome is not the cause of your back pain. Your doctor will evaluate the results of the medial branch block to determine if there are other causes for your pain. This also means that a radiofrequency neurotomy may not be helpful for you either.

Keep in mind that a medial branch block is only a diagnostic measure and that your pain may return to its usual levels after the anesthetic has worn off. Keeping accurate records of your experience after the procedure may help you find relief from future treatment options.


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