Diagnostic Medial Branch Block
What are the facet joints?
The facet joints are the articulations or connections between the vertebraes in the spine. They are like any other joint in the body like the knee or elbow that enable the bending or twisting movements of the spine. The facet joints help support the weight and control movement between individual vertebrae.
The facet joints can get inflamed secondary to injury or arthritis and cause pain and stiffness. To help determine whether your facet joints are a source of your pain, it is necessary to perform a nerve block along the nerves that supply sensation to your joints. Facet Joints are innervated or “supplied” by nerves called “medial branches.” These nerves carry the pain signals to the spinal cord and the signals eventually reach the brain, where the pain is noticed.
If the nerves are “blocked” or “numbed”, they will not be able to carry pain sensation to the spinal cord for the short term. Therefore, if the pain is due to facet joint arthritis, you should have relief from pain and stiffness. This is a diagnostic procedure. You will be given a pain diary to take home for the next twenty four hours. If this does provide short term relief, this procedure may be repeated to confirm diagnosis. Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called “Radio-Frequency Neurotomy” and prevent the conduction of pain information for several months.
What happens during the procedure?
Lying on your stomach, the skin over your neck, mid-back or low back will be well cleaned. The physician will numb a small area of skin with numbing medicine which may sting for a few seconds. The physician will use X-ray guidance to direct a special needle along side the targeted medial branch nerve. Then a small amount of contrast dye will be injected confirming proper placement. Then a small amount of local anesthetic will be injected over the nerve.
What happens after the procedure?
Your arm or chest wall or leg may temporarily feel numb or weak from the anesthetic. A dressing may be applied to the injection site. You will remain for about 15 to 20 minutes and the nurse will monitor your blood pressure and pulse. The nurse will review your discharge instructions and you will be able to go home. A pain diary will be provided for you to keep a record over the next 24 hours. Over that time, you should perform activities (within reason) that normally cause you pain. This will help us determine the success of the injection. After you have finished with the diary, please mail, fax or drop off the completed diary and we will be in contact with you.
General Pre/Post Instructions
You may eat a light, but not full meal at least one hour before the procedure, unless receiving intravenous sedation. If you are an insulin dependent diabetic do not alter your normal food intake.
Take your routine medications before the procedure (such as high blood pressure and diabetes medications) except for those that need to be discontinued five days before the procedure such as aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro). These medicines may be re-started the day after the procedure. If you are taking Coumadin, Heparin, Lovenox, Plavix or Ticlid you must notify the office so that the timing of stopping these medications can be explained.
Things that may Delay the Procedure
If you are on antibiotics please notify our office; we may delay the procedure. If you have an active infection or fever we will not do the procedure.