Lumbar, Cervical, Thoracic Medial Branch Blocks Melbourne

What Are Lumbar, Cervical, and Thoracic Medial Branch Blocks?

A medial branch block is a procedure used to diagnose and treat pain originating from the facet joints in the spine. It involves injecting a local anaesthetic near the small nerves called medial branches that supply sensation to these joints, temporarily blocking the pain signals. 

If the patient experiences temporary and significant pain relief after the injection, it suggests that the facet joints are the source of their pain, aiding in the development of a targeted treatment plan.

Lumbar Medial Branch Blocks

A lumbar medial branch block is a minimally invasive procedure used in the diagnosis and treatment of lower back pain, particularly pain originating from the facet joints in the spine. The facet joints are small joints located between each vertebra in the spine, and they can become a source of pain due to injury, arthritis, or degeneration.

During a lumbar medial branch block, a small amount of local anaesthetic is injected near the medial branch nerves that supply sensation to the facet joints. 

These nerves are responsible for transmitting pain signals from the facet joints to the brain. By blocking these nerves temporarily, the procedure aims to determine if the facet joints are the source of the patient’s pain. If the pain diminishes after the injection, it suggests that the facet joints are indeed contributing to the pain.

Lumbar medial branch blocks are typically performed under fluoroscopic (X-ray) guidance to ensure accurate placement of the needle. They are considered a diagnostic tool because they help doctors confirm the source of the pain before considering more invasive treatments, such as radiofrequency ablation, which aims to permanently disrupt the medial branch nerves to provide longer-term pain relief.

Cervical Medial Branch Blocks

Cervical medial branch blocks are similar to lumbar medial branch blocks but are performed in the neck region of the spine, specifically targeting the nerves called medial branches that innervate the facet joints in the cervical spine. 

These blocks involve injecting a local anaesthetic near these nerves to temporarily block pain signals. They are used both as a diagnostic tool to identify the source of neck pain where the facet joints are implicated as the cause of the pain.

Thoracic Medial Branch Blocks 

Like cervical and lumbar medial branch blocks, thoracic medial branch blocks are a procedure used to diagnose and treat pain originating from the facet joints in the thoracic spine, which is the mid-back region. 

This procedure involves injecting a local anaesthetic near the medial branch nerves that supply sensation to the facet joints. By temporarily blocking these nerves, thoracic medial branch blocks can help determine if the facet joints are the source of the pain in patients with thoracic spine-related pain.

What Do Lumbar, Cervical, and Thoracic Medial Branch Blocks Treat?

Lumbar, cervical, and thoracic medial branch blocks are all used to diagnose and treat pain originating from the facet joints in the respective regions of the spine.

• Lumbar Medial Branch Blocks. These are used to address lower back pain originating from the facet joints in the lumbar spine (lower back). This procedure helps diagnose whether the facet joints are the source of the pain and can also provide temporary pain relief for individuals suffering from lumbar facet joint-related pain.
• Cervical Medial Branch Blocks. These blocks target the facet joints in the cervical spine (neck region). They are employed to diagnose cervical facet joint-related pain and can offer temporary pain relief in cases where the facet joints are identified as the source of the pain.
• Thoracic Medial Branch Blocks. Similar to lumbar and cervical blocks, thoracic medial branch blocks aim to diagnose and treat pain originating from the facet joints in the thoracic spine (mid-back). By temporarily blocking the nerves supplying sensation to these joints, this procedure can help determine if the facet joints are the cause of the pain and can provide short-term pain relief for thoracic facet joint-related pain.

Overall, these procedures are primarily utilised for diagnostic purposes to confirm the facet joints as the source of pain and can also offer temporary relief by interrupting pain signals from these joints. 

Medial branch blocks are often used in conjunction with other treatments such as physical therapy, medications, or more long-term interventions like radiofrequency ablation or neurotomy for sustained pain relief.

How Do Lumbar, Cervical, and Thoracic Medial Branch Blocks Alleviate Chronic Pain?

Lumbar, cervical, and thoracic medial branch blocks alleviate chronic pain by targeting the nerves that transmit pain signals from the facet joints in the respective regions of the spine. Here’s how they work:

• Blocking Pain Signals. These procedures involve injecting a local anaesthetic near the medial branch nerves that supply sensation to the facet joints. By doing so, they temporarily interrupt the transmission of pain signals from the facet joints to the brain. This interruption can provide immediate relief from chronic pain associated with facet joint dysfunction.
• Diagnostic Role. These blocks serve a diagnostic purpose. If a patient experiences significant pain relief after the injection, it suggests that the facet joints are indeed contributing to their chronic pain. This confirmation helps healthcare providers develop targeted treatment plans tailored to the specific source of the pain.
• Guiding Further Treatment. Once the facet joints are identified as the source of the pain, healthcare providers can proceed with additional treatments to provide longer-term pain relief. These may include radiofrequency ablation, where heat is used to disrupt the nerves supplying the facet joints, or other interventions aimed at addressing the underlying cause of the facet joint dysfunction.

Overall, lumbar, cervical, and thoracic medial branch blocks play a crucial role in both diagnosing and alleviating chronic pain associated with facet joint dysfunction in their respective regions of the spine, providing patients dealing with chronic back pain with relief and improving their quality of life.

Why Would You Get Lumbar/ Cervical/ Thoracic Medial Branch Blocks for Chronic Pain?

Lumbar, cervical, and thoracic medial branch blocks are often recommended for chronic pain stemming from facet joint dysfunction in the respective regions of the spine. Here are some reasons why these methods might be used by a pain management doctor:

• Diagnostic Tool. These blocks serve as a diagnostic tool to pinpoint the source of chronic pain. If a patient experiences significant pain relief following the injection, it suggests that the facet joints are contributing to their pain. This information helps healthcare providers develop an appropriate treatment plan targeted at addressing the underlying cause of the pain.
• Conservative Treatment Option. Medial branch blocks offer a minimally invasive and conservative approach to managing chronic pain before considering more invasive procedures or surgeries. They provide temporary relief by interrupting pain signals, allowing patients to experience immediate relief and potentially avoiding the need for more aggressive interventions.
• Facilitate Treatment Planning. By confirming facet joint involvement in chronic pain through medial branch blocks, healthcare providers can develop a tailored treatment plan. This may include further interventions such as radiofrequency ablation or physical therapy aimed at providing long-term pain relief and improving overall function and quality of life.

Overall, lumbar, cervical, and thoracic medial branch blocks are valuable tools in the treatment of chronic upper and lower back pain associated with facet joint dysfunction, providing both diagnostic insights and temporary relief to improve both patient outcomes and quality of life.

The Risks of Lumbar, Cervical, and Thoracic Medial Branch Blocks

While lumbar, cervical, and thoracic medial branch blocks are generally safe techniques, they do carry certain risks and potential complications. Some of the risks associated with these procedures include:

• Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
• Temporary Pain Increase. Some patients may experience a temporary increase in pain following the procedure. This typically resolves within a few days and is often related to the local anaesthetic wearing off or inflammation or muscle spasm at the injection site.
• Infection. There is a risk of infection at the injection site, although this is rare. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
• Bleeding. There’s a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. This can lead to hematoma (collection of blood) at the injection site.
• Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids, are possible but uncommon. If a contrast dye is used during the procedure, there is a slight risk of an allergic reaction to the dye, which may include rash, itching, or more severe reactions like anaphylaxis.
• Nerve Damage. There is a small risk of nerve damage associated with the needle insertion during the procedure. This can lead to numbness, weakness, or other neurological symptoms. However, the risk of significant nerve damage is low, especially when the procedure is performed by experienced healthcare providers using imaging guidance.
• Spinal Cord or Nerve Root Injury. Although extremely rare, there is a risk of injury to the spinal cord or nerve roots during the injection, which can lead to neurological deficits, bowel and bladder dysfunction, numbness and paralysis. 
• Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long term complications (such as cancer) due to exposure to X Ray and/ or CT scanning.
• Failure. The procedure may not provide the expected result or benefit.
• Sedation anaesthesia. There are risks of undergoing the sedation anaesthetic which is discussed on the day by the anaesthetist. Anaesthesia is generally very safe but there may be increased risk depending on your specific medical conditions.

It is essential for patients to discuss the potential risks and benefits of lumbar, cervical, or thoracic medial branch blocks with their healthcare provider before undergoing the procedure. Additionally, these procedures should be only performed by trained and experienced healthcare professionals in a controlled medical setting to minimise risks and ensure your safety.

The Process of Getting Lumbar, Cervical, and Thoracic Medial Branch Blocks

The process of getting lumbar, cervical, or thoracic medial branch blocks typically involves multiple steps:

1. Consultation. The process often begins with a consultation with your pain management specialist and/or an anaesthetist. During this consultation, the specialist will review your medical history, perform a physical examination, and discuss the nature and location of the pain.
2. Diagnostic Evaluation. Depending on the patient’s symptoms and medical history, your doctor may order diagnostic tests such as X-rays, MRI, or CT scans to evaluate the spine and identify any potential sources of pain, such as facet joint dysfunction.
3. Informed Consent. Before the procedure, your healthcare provider will explain the risks, benefits, and alternatives of lumbar, cervical, or thoracic medial branch blocks. The patient will have an opportunity to ask questions and provide informed consent for the procedure.
4. Preparation. On the day of the procedure, you may be asked to refrain from eating or drinking for a certain period before the appointment, depending on the provider’s instructions. You will also be asked to change into a hospital gown.
5. Procedure. The patient will be positioned on an examination table, usually lying face down (prone). The skin over the injection site(s) will be cleansed with an antiseptic solution. The procedure is performed under sedation anaesthesia in the hospital theatre setting.
6. Local Anaesthesia. The doctor will use a local anaesthetic to numb the skin and underlying tissues at the injection site(s). This helps minimise discomfort during the procedure.
7. Injection. Using fluoroscopy (X-ray guidance), the doctor will carefully insert a thin needle into the targeted area near the medial branch nerves that supply sensation to the facet joints. Once the needle is in the correct position, a combination of local anaesthetic and steroid medication will be injected.
8. Post-Procedure Monitoring. After the injection, you may be monitored in the recovery area to ensure there are no immediate complications. You will also be instructed to log your pain levels and any changes in symptoms following the procedure in a Pain chart over the following two weeks.
9. Follow-Up. Depending on the individual response to the procedure, your doctor may schedule a follow-up appointment to assess the effectiveness of the medial branch block in alleviating pain and to discuss further treatment options if needed.

Overall, the process of getting lumbar, cervical, or thoracic medial branch blocks involves careful preparation, precise needle placement, and post-procedure monitoring to ensure patient safety and optimise outcomes.

Preparing for Lumbar, Cervical, or Thoracic Medial Branch Blocks

Preparing for a Medial Branch Block  at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

For a lumbar, cervical, or thoracic medial branch block, it is crucial for your treatment to be able to demonstrate a reduction in your usual pain after the procedure. This is because these procedures serve a diagnostic purpose. We would expect that you have some pain (approximately 5-7/10) prior to proceeding with the diagnostic test on the day.Therefore, we advise stopping any pain medication around five or six hours beforehand

If you are not experiencing pain on the scheduled day of the appointment, we may recommend postponing the procedure to a later date.

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

You must also avoid eating or drinking anything in the six hours leading up to the procedure. However, you may continue to take medications with a small sip of water on the morning of the procedure. You will be advised to cease some other medications such as those for diabetes and blood thinning medications.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND one day after the procedure, to rest and recover from the procedure. 

If you are receiving medial branch blocks, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after receiving a medial branch block. 

Dr Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After Getting a Lumbar, Cervical, or Thoracic Medial Branch Block (Follow-Up)

Following your medial branch block procedure, you are free to return home. 

There are no specific restrictions on your day-to-day activities. However, it is advisable to prioritise rest and engage in gentle activities during the initial 24 hours after your procedure.

Occasionally, you may experience some discomfort or bruising at the injection sites. Occasionally there is a temporary flare up of the pain.

You may commence physiotherapy one week after the procedure. You may return to hydrotherapy or a swimming pool/ spa two weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least two weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 2 weeks post procedure to assess your response to the medial branch block. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you. 

After obtaining a diagnostic medial branch block, a positive test block is considered if there is a significant reduction in pain over the first 4-6 hours after the procedure. Once the local anaesthetic wears off, it is normal for pain to increase to its pre-procedure levels. 

If the pain is not originating from the facet joints, there will be no change to the levels of pain after the medial branch block. This would be considered as a negative diagnostic block. 

Finding a Doctor Who Performs Lumbar, Cervical, and Thoracic Medial Branch Blocks Near You

If you are suffering from chronic neck pain, upper back pain, or lower back pain, then a pain specialist who can perform medial branch nerve blocks may be able to provide some short term relief.

Ask your general practitioner for a referral to a pain management physician who offers lumbar, cervical, or thoracic medial branch blocks or similar procedures for neck and back pain. You can also research pain management clinics online or speak to family members, friends, or support groups (both online and in real life) for recommendations from others with back or neck pain issues.

Lumbar, Cervical, and Thoracic Medial Branch Blocks at Persistent Pain Solutions

The Persistent Pain Solutions clinic provides lumbar, cervical, and thoracic medial branch blocks. These procedures help alleviate neck and back pain by targeting the medial branch nerves in the facet joints that run along the length of your spine. 

Thoracic, cervical, and lumbar medial branch blocks can alleviate some back and neck pain and enable you to effectively engage in rehabilitation, physical therapy, and other longer-term solutions.