Medial Branch Blocks
What is a medial branch block?
At times, it becomes quite difficult for your provider to determine what is causing the pain in your low back, legs, or your neck or arms. Frequently through history, examination, and review of your X-rays, MRI or CT scan, a pain generator can be identified. Once a pain generator has been identified, decisions can be made regarding how best to treat it. Diagnostic medial branch blocks are test injections meant to decrease your pain temporarily and to define it more precisely.
Make arrangements to have a responsible adult accompany and drive you home.
This is for your safety and the safety of others.
Pain and Anatomy:
Pain which is mostly in the back or neck may be coming from one or more of the little guiding joints in the lumbar or cervical area of the spine. These joints are called FACET JOINTS. Just as a joint in your finger, shoulder, or elbow can give you discomfort, so can facet joints in your back. This is a type of “mechanical low back pain” or “mechanical neck pain” and has certain characteristics, which can be identified from your history and physical. In addition, an X-ray, MRI or CT scan might suggest some “wear and tear” or arthritis in these joints.
Initial treatment is usually physical therapy (instructions in exercise, posture, and body mechanics) and all insurance carriers require a course of physical therapy. However, if physical therapy does not resolve the problem, it is possible to block the nerve going to each of these joints to see if the pain can be reduced. If a significant decrease is obtained through the temporary block, there is the possibility a longer lasting block of the nerve, using a radiofrequency probe, could lessen the overall discomfort.
Before the Injection:
- If you are on blood thinners, please let Dr. Lutz and/or his staff that you are taking anticoagulants. Patients on Coumadin / Warfarin require a protime/INR blood test the day before the procedure. Bring these results with you to your appointment.
- In the event that your usual pain is not present the day of the procedure, please call Dr. Lutz’s office to reschedule the block for another day.
- Arrange for a driver as you will be restricted from driving for 4 hours following the procedure both for your own safety and the safety of others.
- Please do not eat or drink anything two (2) hours before the procedure.
- Do not take any pain relievers 6 hours prior to the procedure. Since the purpose of performing the block is to identify and evaluate the structures that influence your pain, taking your pain medication may mask the symptoms that are usually present.
What to Expect:
The test is done by Dr. Lutz using sterile technique and fluoroscopy (a real-time X-ray process). You are awake throughout the procedure and are positioned face down on a table so your vertebral spaces are as widely separated as possible. After the injection site is prepared with an antiseptic solution, a small needle is inserted using fluoroscopic guidance to place additional anesthetic near each of the facet joints to block the tiny facet nerve. During the injection you may experience some pressure or minor pain in the area. Following the injection you should experience almost immediate relief of your pain. This will indicate that the block has been successful.
Following the Procedure:
- After the blocks are completed, the staff will ask you to get up and move around to see if there is any change in your usual pain.
- No driving for 4 hours post procedure.
- Resume your normal diet.
- Resume your normal medications.
- Complete your pain analog sheet and fax to Dr. Lutz’s office (651) 313-8251. The combination of how the pain changes and how long the relief lasts will help your doctor decide if you are a candidate for radiofrequency. If there is no change in your pain, then attention will be directed to other possible sources of pain. If your symptoms improve significantly, additional blocks will be performed later to confirm the diagnosis.
- You may shower after 24 hours. Not tubs or pools for 48 hours.
The potential risks for medial branch blocks are the same as for any procedure involving needle
placement. They include:
- Allergic reaction to the local anesthetic (you will be asked to reveal any known allergies prior to the procedure).
- Infection (this risk is minimized by performing the procedure within the surgery suite using sterile technique).
- Injury to nerve (numbness or muscle weakness).
- A temporary increase in pain at the injection sites.