NASA Neuroscience And Spine Associates, P. L

As with many spinal injections, medial branch blocking procedures are best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve injury or other injury).

On the day of the injection, patients are advised to avoid driving and doing any strenuous activities, and to get plenty of rest the night before.

The injection procedure includes the following steps:

• An IV line will be started so that adequate relaxation medicine can be given, as needed.
• The patient lies on an x-ray table, and the skin over the area to be tested is well cleansed.
• The physician treats a small area of skin with a numbing medicine (anesthetic), which may sting for a few seconds.
• The physician uses x-ray guidance (fluoroscopy) to direct a very small needle over the medial branch Nerves.
• Several drops of contrast dye are then injected to confirm that the medicine only goes over these Medial branch nerves.
• Following this confirmation, a small mixture of numbing medicine (anesthetic) will then be slowly injected onto each targeted nerve.

The injection itself only takes a few minutes, but the entire procedure usually takes between fifteen and thirty minutes.

After the procedure, the patient typically remains resting on the table for twenty to thirty minutes, and then is asked to move the affected area to try to provoke the usual discomfort. Patients may or may not obtain discomfort relief in the first few hours after the injection, depending upon whether or not the medial branch nerves that were injected are carrying discomfort signals from the spinal joints to the brain. On occasion, patients may feel numb or have a slightly weak or odd feeling in their neck or back for a few hours after the injection. The patient will discuss with the doctor any immediate discomfort relief. Ideally, patients will also record the levels of discomfort relief during the next week in a discomfort diary. A discomfort diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed.

Medial branch nerve block results and follow-up:
Patients may continue to take their regular medications after the procedure, with the exception of limiting discomfort medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate.

On the day after the procedure, patients may return to their regular activities. When the discomfort is improved, it is advisable to start regular exercise and activities in moderation. Even if the discomfort relief is significant, it is still important to gradually increase activities over one to two weeks to avoid recurrence of discomfort.

Depending on the amount of discomfort relief the patient has during the first 6 to 12 hours after the injection, the patient may be a candidate for a radio frequency neurotomy procedure to try and provide longer term discomfort relief. Generally, a patient must report at least 80% improvement in their discomfort during the first 6 to 12 hours after the injection to be considered a candidate for radiofrequency neurotomy

Potential risks and complications of medial branch nerve blocks
As with all invasive medical procedures, there are potential risks and complications associated with medial branch blocks. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from a medical branch injection include:

• Allergic reaction. Usually an allergy to x-ray contrast and rarely to local anesthetic.