What is a Medial Branch?
Your Facet Joints (throughout your spine from the top of your neck to your low back) are innervated or “supplied” by nerves called “medial branches”. These nerves carry the discomfort signals from the facet joints 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 from the facet joints. It is like temporarily cutting off “wires”. Therefore, if the discomfort is due to facet joint arthritis, you should have relief from pain and stiffness. Thus the procedure provides us with diagnostic information that facet joints may be or may not be causing your discomfort.
Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called “Radio-Frequency Lesioning” 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. More nerves to be blocked, more time it takes.
What is actually injected?
The injection consists of a of local anesthetic (like lidocaine or bupivacaine) and a small amount of steroid.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues that surround a painful region. Therefore, there is some discomfort involved.
How is the injection performed?
It is performed with the patient lying on the stomach under x-ray guidance. 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 2 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 the next day. The most common thing you may feel is sore back.
How long does the effect of the medication last?
The immediate effect is from the local anesthetic injected. Depending upon the medication injected, it can last from 2 hours to 8 hours. If the facet joints are not the source of your pain, you may not have much relief.
How many injections do I need to have?
Usually one session is enough to determine if the facet joints are the most likely source of your pain or not.
Will the procedure help me?
These are done to determine if the pain is coming from the facet joints or not, and if the pain is coming from the facet joints. Our ability to diagnose facet joint pain is based on a reduction of your pain by at least 70% for several hours after your injection. If we achieve our objective it is likely we will recommend “Radio-Frequency Lesioning” – which will “numb” the same nerves for many weeks to months.
What are the risks and side effects?
With any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding and soreness.