What are Facet Joints & Medial Branch Nerves?
Facets are small joints located on either side of the spine that form the connections between each vertebra. They support, stabilize & limit the movements beyond a certain degree in the spine. Medial branch nerves are very small nerve branches that carry pain messages from facet joints to the brain where they are experienced. A damaged facet joint can cause pain ranging from muscle tension to severe agony. The pain can radiate to different locations depending on which facet joint is injured.
What is a Facet Block & Medial Branch Block?
A facet block is an injection of medicine into the facet joint in the spine. A medial branch block is similar, but the medication is placed outside the joint space near the nerve that supplies the joint called the medial branch.
The only method to know if facet joints are the source of your pain is to numb or “block” the nerves that send pain signals from the joints, known as the medial branch block. If the medial branch block (MBB) relieves your pain, the joint has been identified as the source of your discomfort. If the block does not relieve discomfort, you should examine sources other than the facet. The MBB, like a chest x-ray, is a diagnostic test, not a treatment. As a result, you should not expect the MBB to provide long-term pain relief.
When is a Medial Branch Block Indicated?
- Age > 65 years
- Back pain limiting the sideward bending
- Failed back surgery syndrome.
How is a Medial Branch Block Given?
The patient lies on his/her stomach. With continuous monitoring of your vital signs, the skin of the back or neck is cleansed with antiseptic solution and a local anaesthetic in injected to numb the area. Under fluoroscopy (real-time x-ray), a tiny needle is placed near the facet joint. Fluoroscopy is utilised to precisely and safely position the needle. The physician uses a small bit of dye to determine if the needle is in the appropriate place. After positioning the needle correctly, the region will be numbed with anaesthetic drugs.
How long does the Procedure Take?
The procedure will take 15 to 20 minutes, after which the patient will be monitored for two hours before being discharged. There will be instant relief from pain and numbness surrounding the injection site.
How long does the Effect Last?
The pain relief might be there for several hours. This is strictly a diagnostic block to test if the facet joint are in fact the source of some of your pain. This is why it is very important for you to maintain the pain diary for the next hours to days following this injection and bring it with you to your next visit to the Doctor. Once the effect of the medicine fades off, the pain will likely return and you may have some increased soreness for a day or two.
What Should be Done after a Medial Branch Block?
Following the treatment, the patient is recommended to do all the exercises and take all the medications the doctor has given. The patient may return to work the next day.
Are you an Ideal Candidate for Medial bBranch Block?
You may have facet joint pain if you have had pain in your upper and middle back for more than two months. X-rays and MRIs do not always reveal if the facet is the source of your pain. Blocking the pain signal produced by the medial branch nerves is the best technique to see if you experience pain in these joints. If you have a pain relief of 50% or more, only then you will be able to perceive the injection’s effects. If not, your injection may be rescheduled.
What is the Next Step after the Injection?
If you have a good pain relief, the next step would be planning of radiofrequency treatment of the medial branch nerves. This procedure will provide long lasting pain relief (average of one year). This will be discussed at your next appointment.
Are there any Side Effects of the Medial Branch Block?
Serious side effects and complications are very rare. Pain at the injection site, local bruising, headache, nausea, fainting, or dizziness are some of the most common side effect, which are transient and will subside on their own. The other uncommon complications are infection, bleeding and nerve injury. These complications are minimized by stopping blood thinners, using sterile technique, and fluoroscopy for x- ray needle guidance .
What are the Advantages of Medial Branch Block?
- No surgery required
- 20-minute procedure with same-day discharge
- Minimum side effects or complications
- Quick recovery time
- Decreases the need to take regular painkillers; hence avoid the side effects.