Cervical Thoracic and Lumbosacral Medial Branch Injections

What are the medial branch nerves are why are medial branch injections helpful?
Medial branch nerves are the very small nerve branches that allow one to feel pain from by the facet joints. The nerves do not control any muscles or sensation in your arms or legs. They are located along a boney groove in your low back and neck and over a bone in your mid-back.

These facet joints are often a source of pain. However, it is very difficult to determine whether these joints are painful from x-rays or MRI studies alone.  By performing the injections, one can numb the joints temporarily to see if the pain goes away.  If pain is relieved for three or four hours after the injections, then a treatment called radiofrequency median branch neurotomy can be performed which hopefully will provide long-term pain relief. � 

 
The facet joint is highlighted by the circle.  A small nerve comes off of the larger nerve seen in the photo to supply the joint.  By blocking the nerves to the joint, one can numb the joint temporarily.

Here a needle is placed under fluoroscopy next to the nerve.  A small amount of anesthetic solution is placed on the nerve to numb it.

These injections can be done in the neck, upper and lower back.

What will happen to me during the procedure?
After lying on a x-ray table, your skin will be well cleaned. Next, the physician will numb a small area of skin with numbing medicine which stings for a few seconds. Next, the physician will use x-ray guidance to direct a very small needle over the medial branch nerves. Pain will not be provoked, if at all possible. Next he will inject a small amount of numbing medicine over the nerves. � 

What should I do after the procedure?
After 15-20 minutes you will resume activity and try to provoke your usual pain. Based on your response, we will determine what, if anything, to do next.  No driving for eight hours after the procedure.

General Pre/Post Instructions
You should eat a light, but not a full meal at least 2 hours before the procedure. 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 stop aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro) 3 days before the procedure. These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are on coumadin, heparin, lovenex, plavix or ticlid you must notify the office so that the timing of stopping these medications can be explained. If you are on antibiotics please notify our office, we may wait to do the procedure. If you have an active infection or fever we will not do the procedure. You will need to bring a driver with you. You may return to your current level of activities the next day including return to work.