What is a Medial Nerve Branch Block?

I’ve had a low back issue all my life. Just got a Medial Nerve Branch Block with four injections on each side of the spine. So I wanted to do some research as this is what I found.  









Things to know

Pain level
How painful is a medial branch block?
The injection is safe and comfortable for some people but not for me (some of the injection sites were more painful than others) and feels like getting any other type of shot. Most patients notice pain relief immediately. Most daily activities can continue right after the injection, but it’s a good idea to take it easy for about 48 hours if possible. Medial branch block injections only last a few days at most.
Why was my nerve block so painful?
Because of the volume of the injection, if that injection does get right next to the nerve, the expansion of the tissue from the volume of the injection can actually cause localized stress or stretching of the nerve, worsening the inflammation and pain rather than making it better.
How long does a medial branch block last?
Once the medial nerves have been blocked with an anesthetic most patients experience numbness in the injected area. This numbness allows for immediate pain relief and the relief is intended to last anywhere from 8-24 hours.
What is a medial branch nerve block?
A medial [MEE-dee-uhl] branch block is a type of spinal injection to temporarily block the pain signals coming from the medial nerves. Medial nerves run through the facet [FAS-it] joints. Facet joints are joints in your spine that allow for movement between vertebrae. The facet joints are the connections between the bones of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs, and other parts of the body. These joints also allow the spine to bend and twist, and they keep the back from slipping too far forward or twisting without limits.
What is the next step after the medial branch block?
If you do experience a lasting lessening of your pain, the block may be repeated. If you experience short-term, positive benefits, your doctor may then recommend a second procedure known as a
What is the next step after the medial branch block?
If you do experience a lasting lessening of your pain, the block may be repeated. If you experience short-term, positive benefits, your doctor may then recommend a second procedure known as a Lumbar Medial Branch Radiofrequency Ablation.
Lumbar Medial Branch Radiofrequency Ablation (RFA) is a minimally invasive procedure used to alleviate chronic lower back pain caused by facet joint arthritis or other conditions affecting the facet joints in the lumbar spine. The procedure involves using radiofrequency energy to disrupt the transmission of pain signals from the medial branch nerves that supply the facet joints. Here’s how the procedure typically works:
  1. Preparation: Before the procedure, the patient is positioned on an X-ray table, and the skin in the targeted area is cleaned and sterilized. Local anesthesia is administered to numb the area.
  2. Placement of the needles: Using fluoroscopy (live X-ray guidance), the physician inserts thin, insulated needles called cannulas near the medial branch nerves responsible for transmitting pain signals from the facet joints. The placement of the needles is crucial to ensure accurate targeting of the affected nerves.
  3. Nerve stimulation: Once the needles are in position, a low-level electrical current is applied to stimulate the targeted nerves. This helps the physician confirm that the needles are correctly placed near the medial branch nerves and that they are responsible for the patient’s pain.
  4. Radiofrequency energy application: After confirming the correct needle placement, the physician will apply radiofrequency energy to the targeted nerves. The radiofrequency energy generates heat, which creates a lesion or ablation along the path of the nerve. This process disrupts the pain signals transmitted by the medial branch nerves, providing pain relief.
  5. Monitoring and completion: Throughout the procedure, the patient’s vital signs and comfort level are closely monitored. Once the radiofrequency ablation is complete, the needles are removed, and a small bandage may be applied to the insertion site.
After the procedure, patients may experience some soreness or discomfort at the needle insertion sites, but this typically resolves within a few days. Pain relief from lumbar medial branch RFA can vary from person to person, but it often lasts for several months or even years. In some cases, the procedure may need to be repeated if the pain returns. It’s important to note that lumbar medial branch RFA is not a permanent solution and does not treat the underlying cause of the pain. It is primarily used for pain management and to improve the patient’s quality of life. It is typically recommended after conservative treatments such as physical therapy, medication, or injections have failed to provide sufficient pain relief. As with any medical procedure, there are risks and potential complications associated with lumbar medial branch RFA, which should be discussed with a qualified healthcare professional.  
What happens next if a medial branch block doesn’t work?
The doctor needs to do additional tests to find the root cause of the pain. Tests include MRIs, bone scans, or nerve tests. There could be an underlying nerve condition, an issue with discs, or spinal stenosis. In the interim, the patient can still use medication, physical therapy, and lifestyle changes to manage pain.
What are the side effects of a medial branch block?
Commonly encountered side effects are increased pain from the injection (usually temporary), rarely infection, bleeding, nerve damage, or no relief from your usual pain.
What is the difference between a nerve block and a medial branch block?
Two of the most common are facet blocks and medial branch blocks. A facet block is an injection of an anesthetic combined with a steroid into a spinal joint. A medial branch block is pretty similar, except the medication is injected outside the joint and closer to nerves (the medial branch nerves).
Can a medial branch block make pain worse?
The most common side effect of this procedure is simply causing more pain. A few patients report that the pain is worse after the medial branch block. This also is a rare complication, fortunately, but it is a possibility. Most patients do very well with this procedure, and worsening pain is never one of our goals.
Is a medial branch block the same as an epidural?
While both procedures are highly effective in reducing pain, they are not used interchangeably. They each have a precise way of targeting pain and are prescribed based on the patient’s specific injury and test results.
How safe are medial branch blocks?
Medical reports have shown that medial branch blocks are safe and effective for neck and back pain. This procedure is also quite beneficial in that it is non-invasive and helps patients avoid having to undergo surgery.
Can medial branch block cause paralysis?

Nerve or spinal cord damage or paralysis. While very rare, damage can occur from direct damage caused by the needle insertion and movement, infection, or bleeding into the area resulting in compression, or injection into an artery causing blockage.
How do they inject a medial branch block?

The area of the skin to be injected is cleaned properly and a local anesthetic is administered to numb the skin. A stinging or burning sensation may be felt for a few seconds. A small needle is then directed into the medial branch nerve area, under X-ray (fluoroscopy) guidance.
What is the risk of nerve block injections?
A nerve block can lead to bleeding and infection where the shot was given, the medicine may spill into other areas unexpectedly, and healthcare providers may hit the wrong nerve during surgery. Compared with many procedures, however, nerve blocks appear to be quite safe.
Can medial branch block help sciatica?
A lumbar medial branch block is a numbing injection administered to the nerves of an inflamed facet joint in the lower back. The medication ‘blocks’ pain signals, relieving lower back pain and sciatica.
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