Medial Branch Blocks
Performed by top Pain Management doctors in Alaska
A Medial Branch Block (MBB) is a pain management technique that helps to greatly reduce the inflammation and irritation around the facet joints in the spine. The facet joints are small-paired joints that connect to each vertebrae of the spine. The medial branch nerves found near facet joints are responsible for sending pain signals from the facet joints to your brain. When traditional physical therapy and oral medications fail to work, it is recommended that the patient undergo an MBB procedure if the pain stems from the facet joints. MBBs are a minimally invasive treatment typically reserved for treating arthritis, neck pain and referred headaches, and upper, mid, and low back pain.
The MBB is a nerve block, and a nerve block in the medical sense, is an injection that “blocks” pain from reaching the central nervous system. Nerve blocks are used to help diagnose the source of pain, create temporary pain relief for patients and can also be used to predict the outcome of a surgery meant to permanently block the activity of certain nerves. An MBB is a block that concentrates on the medial branch nerves (the small nerves that innervate the facets of the spine) to temporarily reduce or stop pain. The nerves in the facet joints only control small muscles in the neck, mid and low back, but are often the culprit for referred head pain, in addition to neck and low back pain. A successful MBB is where the patient has a significant decrease of pain in the affected areas. If the MBB is successful, then the patient might be a likely candidate for radiofrequency ablation, a longer lasting pain management treatment (Baker).
Radiofrequency ablation is a treatment that uses heat produced by the electric currents (RF currents) to create a lesion on a nerve, thereby disrupting the painful sensations from being acknowledged by the central nervous system.
MBB is a procedure that is commonly used to treat:
- Low back pain. Low back pain is often caused by arthritis in the facet joints around the Lumbosacral medial branch nerves (located in the groove of the low back). In fact, inflamed or irritated facet joints account for spinal pain in 15% to 45% of patients suffering from low back pain (Boswell). In a clinical study, 57 patients who suffered from low back pain were given an MBB, and after eight weeks, 53% of patients claimed relief. At six months after the injection, the number increased to 68% of patients who reported improvement (Anand et al).
- Neck pain. A primary cause of neck pain and referred head pain stems from the cervical facet joints located at the bony groove of the neck. In a recent study, 36% to 67% of patients suffering from neck pain attributed that pain to inflamed or irritated facet joints (Boswell).
In essence, this procedure is a minimally invasive, non-surgical treatment that is essentially an injection to the medial branch nerve at the facet joints. It is a fairly simple procedure and pain relief will typically occur within minutes of the injection.
The first step in this procedure is to numb the injection site(s) — where the facet joints are located — with a local anesthetic. After the injection area is sufficiently numb, an injection comprised of a long-lasting steroid and a local anesthetic is made using fluoroscopy (live x-ray) guidance. The steroid is used to reduce irritation and inflammation and the anesthetic numbs the nerve. Usually, this procedure takes around 15 to 30 minutes. After the injection is completed, the patient is required to rest for 20 – 30 minutes before going home (Baker). If the procedure is successful, the suggested frequency of injections should not occur any sooner than two months after the injection. If the treatment is being used as a diagnostic, the patient should not receive more than four MBBs per year. If the patient is in the therapeutic stage, they should not receive more than six MBBs per year (Manchikanti et al).
Often used as a prognostic and diagnostic treatment, MBB has a variety of uses in pain management (Manchikanti et al). In a guideline for chronic spinal pain management created by the American Society of Interventional Pain Physicians, it points to the notion that MBBs are extremely beneficial when used to diagnose lumbar and cervical facet join pain (Boswell 2007). It is typically more difficult to diagnose facet joint pain with traditional pain management modalities such as physical therapy and chiropractic, which is why MBB has become so prominent in recent years as the best way to diagnose facet joint pain. It is important to note that MBB is not a long-term solution of pain management for those that suffer from neck pain or upper and lower back pain. However, one of its greatest benefits is its rapid relief from painful symptoms. Pain relief will often last anywhere from one month up to a year (Boswell) and provides patients relief when oral medications and physical therapy fails. If the MBB is successful, then the patient will most likely benefit from radiofrequency ablation, a more long-term pain management technique.
The MBB is considered a safe procedure, but as with all medical procedures there are associated risks, possible side effects and complications.
- As the local anesthetic wears off, the patient might experience tenderness at the injection area for a short period of time.
- In less than 1% to 2%, minor infections occur.
- In a small group of patients, the pain symptoms can become worse.
- If the patient is on blood thinning medications, has an active infection, pregnant or allergic to any of the anesthetics used, caution is advised as the patient might suffer excessive bleeding, infection and nerve damage as a result.
- While very rare, there is a possibility of nerve or spinal cord damage or paralysis resulting from direct trauma from the needle, from an infection, bleeding resulting in compression or injection into an artery causing blockage (Baker).
The Medial Branch Block is an effective procedure that can create immediate relief in those suffering from chronic neck, back and low back pain. It is also extremely effective as a prognostic and diagnostic treatment, especially in determining if radiofrequency ablation is a relevant longer-term form of pain management therapy. There is minimal risk, and minimal recovery time involved, making MBBs a preferred procedure for facet joint-related pain.
- Anand, S., Muhammad, S.SM. (2007). Patients’ response to facet joint injection. Retrieved from http://www.actaorthopaedica.be/acta/download/2007-2/13-Anand%20et%20al.pdf
- Baker, RM. Cervical, Thoracic and Lumbar Facet Joint Injections. Spine-Health. Retrieved from http://www.spine-health.com/treatment/injections/cervical-thoracic-and-lumbar-facet-joint-injections
- Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L. (2007). Interventional Techniques: Evidence-based Practice Guidelines in the Management of
- Chronic Spinal Pain. Pain Physician. Retrieved from http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf
- Manchikanti, L., Damron, K., Cash, K., Manchukonda, R., Pampati, V. (2006) Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial. Pain Physician. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17066118