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Medial Branch Block Injections

Medial Branch Blocks (MBBs) are primarily used to alleviate neck and back pain associated with arthritis. These blocks are a minimally invasive procedure that is done in clinic. Medial branch blocks work by reducing inflammation and irritation in the facet joints. If the procedure proves to be beneficial, radiofrequency ablation, a more long-term solution, will often be the next step to return the patient back to their normal lifestyle.


Utah Medial Branch Blocks Treatment


Medial branch blocks are done in an outpatient setting (usually in the clinic) and generally take about 15 minutes to perform. The patient will be asked to lie on their stomach, giving the doctor access to the spine. Fluoroscopy must be used to identify the location of the medial branch nerve. The skin and deep tissues will be anesthetized with local anesthetic. Using fluoroscopy, a needle will be inserted into the anticipated location of the medial branch nerve, and a long-lasting steroid and a local anesthetic will then be injected. The expected results include a reduction of inflammation and irritation and numbing of the pain.

There are two phases of this procedure:


  • The first phase is called the local anesthetic phase and can last anywhere from 1-4 hours. During this phase, the medial branch nerve is unable to conduct pain signals from the joint — this provides relief.

  • The second phase is the anti-inflammatory phase. This phase occurs only if steroid is used in the injection. During this phase, pain is relieved by reducing inflammation in the facet joint. This phase should start between days 3-7 after the procedure, and if effective, may last up to 3-4 months — rarely longer.

Patients who benefit from phase I with a short or no phase II are excellent candidates for a radiofrequency rhizotomy (aka ablation) procedure. If you have been deemed an RFA candidate in the past and have had excellent relief with that procedure, there is no need to repeat the MBB unless you have not had the MBB and/or RFA at the particular level of suspected pain.


Risks and Benefits of a Medial Branch Nerve Block Injection


Patients may receive considerable relief of symptoms almost immediately after the procedure, and therefore will be able to resume normal activities that were unachievable with oral medication and physical therapy alone. Medial branch blocks are typically used as a diagnostic test to see if the pain originates in the facet joint or if another route must be taken to attain relief of neck and/or back pain. Because MBBs are non-surgical and minimally invasive, the patient does not need general anesthesia. However, some patients may tolerate the procedure with light sedation if they have significant anxiety associated with procedures.


Potential risks involve misplacement of the needle, bleeding, infection, and nerve damage. There are also possible side-effects from medications used in the procedure, but they are much lower than in patients using oral medications. They include weight gain, elevated blood sugars, stomach ulcers, and transient decrease in the immune system.


Outcome and Success of a Medial Branch Nerve Block


Medial branch blocks are becoming more common because of the great success rate in reducing pain in patients who have undergone the procedure. Even when full pain relief is not achieved through the procedure, it works as a great diagnostic test and helps the physician correctly diagnose a particular patient's origin of pain. Because back and neck pain can be caused in a number of different ways, a doctor will need to review history and symptoms before selecting a procedure to best benefit the patient.

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