Medial Branch Nerve Blocks - Spine-health

The primary purpose of medial branch blocks is to diagnose or pinpoint pain originating from a facet joint(s) and guide further treatment if a positive response is seen.1Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiology. Published online October 17, 2022. doi: 10.1007/s00256-022-04184-5,3Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Facet joint interventions. Neurol Clin Pract. 2014;4(4):342-346. doi:10.1212/CPJ.0000000000000044

• Diagnostic: Significant pain relief following the anesthetic injection suggests that the facet joints are involved, while lack of pain improvement indicates they are likely not the main contributor to pain.1Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiology. Published online October 17, 2022. doi: 10.1007/s00256-022-04184-5,3Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Facet joint interventions. Neurol Clin Pract. 2014;4(4):342-346. doi:10.1212/CPJ.0000000000000044
• Treatment planning: A positive response to medial branch block injections also indicates that a patient will likely benefit from medial branch radiofrequency ablation (RFA) treatments that involve creating heat lesions on the nerves to prevent long-term pain signaling.1Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiology. Published online October 17, 2022. doi: 10.1007/s00256-022-04184-5,3Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Facet joint interventions. Neurol Clin Pract. 2014;4(4):342-346. doi:10.1212/CPJ.0000000000000044

RFA treatments are preferred as they offer longer pain relief (6 to 12 months) and are not associated with the potential risks linked to repeated corticosteroid use.4Cohen SP, Doshi TL, Constantinescu OC, et al. Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial [published correction appears in Anesthesiology. 2018 Sep;129(3):618]. Anesthesiology. 2018;129(3):517-535. doi:10.1097/ALN.0000000000002274

See Radiofrequency Ablation (RFA) Side Effects and Risks

Less commonly, medial branch block injections are used therapeutically after a positive diagnosis and involve injecting a combination of an anesthetic and a corticosteroid for sustained pain relief (2-4 months).5Manchikanti L. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2020;3S;23(5;3S):S1-S127. doi: 10.36076/ppj.2020/23/s1,6Lee DG, Ahn SH, Cho YW, Do KH, Kwak SG, Chang MC. Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain. Spine (Phila Pa 1976). 2018;43(2):76-80. doi:10.1097/BRS.0000000000002269