Before discussing what a medial branch block is, we feel it is important to first understand what we are trying to treat. Medial branch blocks are the first step in diagnosing back or neck pain caused by arthritis or whiplash injury. Arthritis and whiplash injuries occur in the posterior aspect of the spine, in the facet joints. Your physician at Restore Medical partners will explain more in person with visual aids to show you what a facet joint is. They are the small joints that allow your spine to flex and twist. We have also provided you with a video to watch to help you understand what a facet joint is and what we are trying to treat.

To view a video about spinal arthritis and facet joint anatomy, please click here.

Back and neck pain can be very complex, other times very simple to treat. The first step in treating your back pain is to determine what portion of your pain is coming from arthritis (or from your facet joints), what portion is coming from degenerative disc disease or from disc tears, what portion is coming from disc pinching nerves (or radiculopathy, aka “sciatica”). We use the medial branch block as a diagnostic treatment to help us understand how much of your pain is coming from your facet joints.

Each level of the spine is connected by facet joints. These facet joints are innervated by two small branches of the larger spinal nerves, called the medial branches. These are nerves that carry pain signals from the facet joint to the brain. Facet joints can be a significant source of pain, especially those with a history of trauma, whiplash injury, degenerative disc disease, and/or advanced arthritis.

When other structures in the spine become weak, the facet joints often become hypertrophic or enlarged. Physical examination and imaging studies can provide a diagnosis of facet joint pain, or spondylosis, but for a more definitive diagnosis and treatment, an injection is often required.

Medial Branch Nerve Blocks are injections of local anesthetic and anti-inflammatory corticosteroid near the nerves that innervate a particular facet joint. Typically, several levels are injected at once: the affected level, and the levels above and below that innervate it. Sometimes, a medial branch block can provide lasting relief for months to years if used in combination with physical therapy. More commonly, medial branch blocks are used to numb your nerves for 4-6 hours to see how much of your pain goes away while your medial branch nerves are numb. If dramatic (greater than 50%) pain relief is achieved, then a confirmation of the facet disease/spondylosis can be inferred. Patients who receive significant benefit from medial branch blocks, but for only a short period of time (like hours to days) will typically be recommended for radio-frequency/ablation of those same nerves. Please see our section about radio frequency ablation to learn more about what this is and how it can relieve your pain for years to come. Some patients may get sustained relief with medial branch blocks and may not have to proceed with radio frequency ablation.

To watch a video about facet injections click here.