Pain in the back or neck can be
caused by a group of nerves, joints, facets, ligaments or muscles.
When more conservative methods of pain control and diagnosis are
ineffective, specialized procedures may be indicated.
One such procedure to treat refractory back or neck pain is the median
branch block. This block can be performed in the cervical, thoracic,
or lumbar areas of the spine, depending upon the site of pain or
pathology. Injecting medications into these nerves may decrease the
pain due to facet joint pathology, as well as for certain problems
stemming from ligament or bursa trauma. This type of nerve block
assists in the diagnosis of a pain problem, and helps the physician in
the decision process as to proper course of more permanent therapy.
Pain following spinal surgery is often caused by irritation and
inflammation of the structures that give support to the bones of the
spine. When spinal surgery is performed, much of the posterior
supporting elements are removed, which results in substantially
increased mobility of the spine. Unfortunately, the increased mobility
is not of the desired nature, and the joints, ligaments and bursa
along the posterior elements of the spine are continually damaged with
movement and motion. This pain is often treatable with median branch
blocks. Unfortunately, spinal fusion is often the only therapeutic
option offered to the patient. This is essentially an irreversible
decision, and the consequences are often devastating.
The medial branch block is performed with the assistance of a special
x-ray machine (fluoroscopy) which enables the physician to accurately
locate the nerve, and document for future use; if the procedure needs
to be repeated. A small volume of local anesthetic (numbing medicine)
is injected, and the response is then observed for the next day or so.
If the pain improves for a period of several hours after the injection
of the local anesthetic, the patient may be a candidate for the more
long-term treatment, which involves destruction of the nerve through
the technique of radio frequency denervation. This procedure, done
through a needle probe, avoids the need for traditional surgical
exploration, and thereby reduces surgical risks, decreases recovery
times, and tremendously reduces cost.
Medial branch block is much safer than surgery, and if the block is
successful, surgery is often avoided. If the procedure is
unsuccessful, the surgical options can be entertained.
