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MEDIAL BRANCH NERVE BLOCK

Pain in the back or neck can be caused by a group of nerves, joints, facets, ligaments or muscles. When more conservative methods of pain control and diagnosis are ineffective, specialized procedures may be indicated.

One such procedure to treat refractory back or neck pain is the median branch block. This block can be performed in the cervical, thoracic, or lumbar areas of the spine, depending upon the site of pain or pathology. Injecting medications into these nerves may decrease the pain due to facet joint pathology, as well as for certain problems stemming from ligament or bursa trauma. This type of nerve block assists in the diagnosis of a pain problem, and helps the physician in the decision process as to proper course of more permanent therapy.

Pain following spinal surgery is often caused by irritation and inflammation of the structures that give support to the bones of the spine. When spinal surgery is performed, much of the posterior supporting elements are removed, which results in substantially increased mobility of the spine. Unfortunately, the increased mobility is not of the desired nature, and the joints, ligaments and bursa along the posterior elements of the spine are continually damaged with movement and motion. This pain is often treatable with median branch blocks. Unfortunately, spinal fusion is often the only therapeutic option  offered to the patient. This is essentially an irreversible decision, and the consequences are often devastating.

The medial branch block is performed with the assistance of a special x-ray machine (fluoroscopy) which enables the physician to accurately locate the nerve, and document for future use; if the procedure needs to be repeated. A small volume of local anesthetic (numbing medicine) is injected, and the response is then observed for the next day or so. If
the pain improves for a period of several hours after the injection of the local anesthetic, the patient may be a candidate for the more long-term treatment, which involves destruction of the nerve through the technique of radio frequency denervation. This procedure, done through a needle probe, avoids the need for traditional surgical exploration, and thereby reduces surgical risks, decreases recovery times, and tremendously reduces cost.

Medial branch block is much safer than surgery, and if the block is successful, surgery is often avoided. If the procedure is unsuccessful, the surgical options can be entertained.

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