Conditions Treated

Of all of the levels of our spine, none works harder than the lumbar region. Your lower back vertebrae stretch from the bottom of your rib cage to the top of the sacrum (the triangular bone at the base of the spine). All in all, we have five or six large vertebrae that allow us to twist, flex, and dance our way through our daily lives.

Sometimes this mobility is what gets us in trouble. Our spinal cord ends at the top of the lumbar spine, but this doesn’t make it immune to nerve pain. Each vertebra of the spine is connected to its neighbors above and below with facet joints. These joints help provide stability even as we move through our day, but they are also susceptible to wear and tear.

Wrapped around each facet joint is a web of nerves called medial branch nerves. They are responsible for sensations to the body (only limited small muscle control). When the lumbar spine is injured or suffers from a pain condition, the medial branch nerves will let you know with pain and other symptoms.

Some conditions that lumbar medial branch blocks can help ease include:

• Osteoarthritis
• Degenerative disc disease
• Herniated disc
• Facet joint disease or injury
• Compression fracture
• Post-operative pain

If your pain from any of these conditions is temporarily relieved with a medial branch block, it means that you may be a good candidate for lumbar medial branch radiofrequency ablation. This is a longer-lasting procedure to manage pain. It uses electrical currents to produce heat that damages the pain-signaling nerves. Many patients find long-lasting relief with this procedure.

Benefits

Lumbar medial branch block benefits extend from pain relief to diagnosis.

How does this procedure work as a diagnostic tool? If the root cause of your lower back pain isn’t identified, it can be hard to really tailor a comprehensive treatment plan. If a medial branch block is successful, it shows that your pain likely originated in these medial branch nerves, versus another cause. This allows them to tailor treatments specific to this area of your spine.

Other lumbar medial branch blocks benefits include:

• Transformative pain relief that lasts for weeks or months
• The short, easy recovery period
• Minimal side effects
• Decreased reliance on pain medications
• Restored mobility in the lower back

When combined with lumbar medial branch radiofrequency ablation (also called neurotomy), lumbar medial branch blocks offer good, long-term pain relief.

Procedure

The lumbar medial branch blocks procedure is performed on an outpatient basis. It takes less than an hour, starts to finish. Bring a friend or family member to give you a ride home, especially if you plan on receiving sedation for the procedure. Most patients do not need sedation but talk to your doctor if you are anxious or concerned about pain.

To begin, you’ll position yourself face down on the exam table. Your doctor prepares the area to be injected with a sterilizing solution and injects a local anesthetic. You might feel the pinch of the needle, but that is brief.

Once you are comfortable, your doctor uses fluoroscopic (X-ray) guidance to place a needle above the medial branch nerves in the epidural space. They then inject a small amount of contrast dye to ensure the medication is directed into the correct area. Once the placement is confirmed, your doctor injects numbing medication to cover the medial branch nerves.

After the injection, you’ll move to a recovery area for a bit before you are released to go home.

Some people experience immediate, total pain relief. Others may find a small increase in pain followed by relief. If your pain is reduced by 50% or more, it shows you are a good candidate for lumbar medial branch radiofrequency ablation.

Recovery

The lumbar medial branch blocks recovery is swift, with few restrictions or complicated directions to follow.

After you get home, take 24 hours to rest. Keep track of your pain levels during this time so you can let your doctor know if the block was effective for you. Limit vigorous activity for the first 24 hours, but feel free to eat and drink as normal and take your usual medications as directed by your doctor.

If you experience pain and swelling at the injection site, use ice and non-steroidal anti-inflammatory medications as directed by your doctor. In general, you can return to your regular levels of activity 24 hours after your lumbar medial branch blocks procedure.

Risks

As with every medical procedure, there are lumbar medial branch block side effects to consider. These side effects are minor and temporary, and may include:

• Soreness at the injection site
• Mild swelling
• Minor bruising
• Temporary numbness at the injection site

More serious but exceedingly rare lumbar medial branch block risks are possible. There is a risk of infection. Watch for a fever of 101 or higher or excessive swelling, bleeding, or oozing from the injection site. Additionally, some people have an allergic reaction to the injected medications. Talk to your doctor if you have a history of an allergic reaction to anesthesia.

In extremely rare cases, improperly placed injections can result in nerve paralysis or tissue damage. This is rare and can be prevented with the use of X-ray guidance and working with a highly-qualified pain specialist.