Medial Branch Nerve Blocks

Medial branch nerve blocks are essentially diagnostic blocks to denervate the facet joints where patients have pain. This is mostly due to axial or mechanical back pain, pain with flexion, extension, lateral rotation, pain that is really localized to their back, it is not extending to the legs, it is not a pinched nerve or herniated disc. This is related to degenerative changes of their back, so mostly arthritic changes if you will. So what we do in that case is we take x-ray image under fluoroscopy, live fluoroscopic images in the operating room, and we’ll place a needle through fluoroscopic guidance straight down to the medial branch nerve. That nerve, again, innervates the joint, so if we block that nerve, we can simultaneously stop the pain. Now this block is only diagnostic, it does not usually last very long, up to maybe a week. From there, we are able to do a secondary procedure which is more definitive. That is called a radiofrequency ablation, and that is when we actually take a similar needle that is attached to a computer, if you will, that actually burns a small lesion across the nerve, about 5 to 8 millimeters of a lesion. That process will alleviate pain or control pain for 6 to 8 months. So most insurance carriers require us to do two diagnostic blocks of the medial branch nerve, and once those have 50 to 60% reduction in pain, we can proceed on to the treatment modality which is the radiofrequency ablation.