Diagnostic Medial Branch Blocks

If you are suffering from chronic neck, mid-back, or low back that has not responded to conservative treatments, Dr. Gilthorpe may recommend a Diagnostic Medial Branch Block (DMBB). This procedure is used to determine if the source of your pain comes from the facet joints of your spine.​

 

What Is a Diagnostic Medial Branch Block?

A diagnostic medial branch block (DMBB) is a minimally invasive diagnostic procedure used to identify whether the facet joints (or zygapophyseal joints) in your spine are causing your pain. Facet joints are the joints located between each vertebra in the spine that allow for flexibility and movement. They may degenerate with time, wear-and-tear, or other degenerative spine conditions. Medial branch nerves carry pain signals from these joints to the brain. During an MBB, a local anesthetic is injected near the medial branch nerves to temporarily block pain signals. If you experience significant pain relief after the injection, it indicates that your pain is likely coming from the facet joints.

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Is a Diagnostic Medial Branch Block for Me?

A Diagnostic Medial Branch Block may be recommended if:

• You have chronic pain in your neck, mid-back, or lower back that may be related to arthritis or other degenerative spine conditions.

• Your pain persists despite conservative treatments such as medications, physical therapy, or lifestyle changes.

• Imaging tests, like MRI or X-rays, show signs of facet joint degeneration or damage.

• Your healthcare provider needs to confirm if the facet joints are the cause of your pain before moving forward with more definitive treatments, such as radiofrequency ablation.

 

What Are the Benefits of a Diagnostic Medial Branch Block?

• Accurate Diagnosis: MBB helps determine whether your pain is coming from the facet joints, guiding further treatment options.

• Minimally Invasive: The procedure is done with a needle and does not require surgery.

• Short Recovery Time: Since the procedure is minimally invasive, recovery is usually quick.

• Immediate Pain Relief: Although temporary, the anesthetic can provide immediate pain relief, which also helps confirm the source of the pain.

 

What Are the Risks?

While Diagnostic Medial Branch Blocks are considered safe, there are potential risks, including:

• Temporary increase in pain: Some patients may experience increased pain or discomfort at the injection site shortly after the procedure.

• Bleeding: Rarely, bleeding may occur, especially in patients with bleeding disorders or those on blood thinners.

• Infection: There’s a very small risk of infection at the injection site.

• Nerve damage: While extremely rare, there is a risk of damaging nearby nerves.

• Allergic reaction: Although rare, some patients may experience an allergic reaction to the medications.

 

How Do I Prepare for a Diagnostic Medial Branch Block?

Preparing for an diagnostic medial branch block involves a few important steps:

• Please call and reschedule if you have an active infection

• Wear loose, comfortable clothing that allows easy access to your back or neck

• Inform Dr. Gilthorpe of the following:

  • Allergies, or medication sensitivities

  • If you take blood thinners (such as clopidogrel/ Plavix, ticagrelor/ Brilinta, apixaban/ Eliquis, warfarin/ Coumadin, rivaroxaban/ Xarelto, enoxaparin/ Lovenox, heparin, or others)

• Blood thinners do NOT need to be held prior to your diagnostic medial branch block

• Fasting is NOT necessary for injections completed in the clinic

• A driver is NOT necessary injections completed in the clinic

 

What if my diagnostic medial branch block is scheduled in the hospital?

Diagnostic medial branch blocks are typically scheduled in the clinic. In limited circumstances, they may be scheduled in a hospital or surgical center. If your DMBB is scheduled at a hospital:

• You need to fast (including food and water) after midnight, the night before

• A responsible adult needs to accompany you to drive after anesthesia.

• The hospital will contact you to: 

  • Give you an arrival time

  • Let you know if any preoperative testing is necessary prior to anesthesia

 

How Is the Diagnostic Medial Branch Block Done?

A Diagnostic Medial Branch Block typically takes 10 minutes and is performed on an outpatient basis. Here's what to expect:

1. Safety-Check: Your vitals will be checked and the procedure site will be confirmed.

2. Positioning: You will lay face down on an X-ray table. You may be asked to change into a gown if the area is not easily accessible.

3. Cleansing the area: The skin around the injection site will be cleaned with antiseptic to minimize the risk of infection.

4. Draping: A small drape with be placed over the area to maintain sterility

5. Fluoroscopy (X-ray guidance): Dr. Gilthorpe will use fluoroscopy, a type of real-time X-ray, to guide the needle to the nerve.

6. Local anesthesia: A local anesthetic is used to numb the area where the injection will be given.

7. Injection: Once the needle is correctly positioned, the medication is injected near the medial branch nerve.

8. Band aid: A band aid will be placed over the site.

9. Monitoring: After the injection, you will be observed for a short time (about 20 minutes) to ensure there are no immediate complications.

 

Post-Procedure Care and Restrictions

After a medial branch block, you can return to normal activities

• Monitor improvement in pain; focus on the first two to four hours after the injection

• Mild soreness at the injection site is common. Placing ice over the injection site for no more than 20 minutes at a time can help relieve this soreness.

• Serious side effects are very rare

• But if you have any of the following, you should go to an Emergency Room.

• New weakness and numbness after the initial weakness and numbness wore off; or persistent weakness over 24 hours.

• Severe swelling, redness, or drainage at the procedure site.

• New urinary incontinence.

• High fever.

 

How long will a Diagnostic Medial Branch Block last? How often is it done?

The pain relief from a diagnostic medial branch block is immediate (within 20 to 60 minutes), short-lived, lasting anywhere from a few hours to a couple of days.

If the initial DMBB helped significantly, then a second DMBB will be completed to confirm the results.

After two successful DMBBs, the next step is [radiofrequency ablation] to provide longer-lasting pain relief (typically 6 to 18 months).

 

Frequently Asked Questions (FAQs)

Q: Is this procedure painful?

A: You may feel mild discomfort at the injection site, but a local anesthetic is used to minimize any pain. Some patients experience a slight pressure or tingling sensation during the injection.

Q: What happens if the injection doesn’t relieve my pain?

A: If the block does not provide significant pain relief, it suggests that your pain may not be originating from the facet joints. Dr. Gilthorpe will explore other potential causes and treatment options.

Q: How often can I have a medial branch block?

A: Since the MBB is primarily a diagnostic tool, it is typically done only once or twice. If successful, more definitive treatments such as radiofrequency ablation are recommended rather than repeating the block.

 

Summary

A Diagnostic Medial Branch Block is an effective way to determine if you are a candidate for a Radiofrequency Ablation to help with chronic neck or back pain.

For more information or to schedule a consultation, [request an appointment here] or call us at 832-286-4546.