Medial Branch: Nerves that tell the joint it has pain
Frequency: Usually performed on one side in at least 4 different levels. The majority of time this is done with you lying on your stomach but if this is difficult for you, you may be able to have this done while lying on your back. This is normally done on your most painful side as there are times that one side of your neck is causing you to have pain on both sides of your neck. This is performed at least once and possibly twice to confirm that your pain is coming from the joints in your neck.
The number one cause of mechanical neck pain is arthritis in the joints of your neck (see cervical facet syndrome). The neck pain can radiate to your shoulders and upper back but usually does not travel past your elbows. If it does, you may have cervical radiculopathy as well. Cervical facet syndrome is typically not fixed by surgery.
All pain is transmitted by nerves. Medial branch nerves carry the pain signals to the joint. By numbing these nerves, this injection is used to diagnose if your pain is coming from the arthritic joints in your neck. In most cases, this will not give you long term relief but is necessary to determine if you would be a candidate for a procedure that can give you prolonged relief, on average 6 months (see cervical facet denervation). Cervical medial branch blocks can help diagnose where your pain is coming from so that treatment can be directed at the cause of your pain.
Contraindications/Reasons why you may not have your injection today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Numbness in upper extremities that is short lived
- Allergic reaction to medications used to clean your skin and/or medications injected
- Nerve and/or spinal cord injury
- Visual changes
During the procedure, you will be lying on your stomach. An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain based upon where you hurt in your neck. After your skin is cleaned with an antiseptic solution, normally betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. The skin is numbed with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected. Another needle is then placed through the numb area of your skin and guided by the x-ray machine to the location of where the nerve resides. This is done at several different locations on your neck. After all needles are in place, additional local anesthetic is placed on the nerves and the needles are then removed. You may experience increased pressure in your neck/shoulder region which is normal. On rare instances, your arm may go a little numb but this normally resolves in several hours. If at any time the pain is too intense during the procedure, please tell your physician. After the medication is injected, the needles are removed and the procedure is completed.
Typical length of the procedure: 10 minutes. Expect to be at the clinic no more than 15 minutes after you have been checked in by the medical assistant into the preoperative area. If this is your first time at our clinic, you will likely be at the clinic for at least one hour. Please plan accordingly.
How long do you expect pain relief: Remember, this is purely a diagnostic procedure so your pain relief will likely not last for more than 6 hours. The area that is normally painful to you may feel numb. If the nerves are the reason why you hurt, this is to be expected. You will receive a pain diary to keep track of your pain for the remainder of the day to make sure that your normal pain has improved by at least 50%. Please disregard pain from the injection itself and/or any muscular spasms that can result from the procedure itself. If you do have relief, you may be a candidate for cervical radiofrequency denervation of these nerves so that you will have the same pain relief for, on the average, 6 months.