Medial Branch Blocks / Radiofrequency Ablation
Pain can originate from one of many potential sources. One such source are the joints of the spine called the facet joints (cervical or lumbar depending if it’s the neck or low back) that can be affected by arthritis, repetitive motion/stress, body weight, and trauma. Each joint is supplied by two small nerves called medial branches, which are sensory fibers that transmit pain from the joints.
There are pain procedures that can target the facet joints. One common treatment is called Radiofrequency Ablation (RFA), which is a 3 step process. Each step is performed under fluoroscopic guidance (x-rays). Because they are considered advanced procedures, they will need to be approved by your insurance carrier.
Step 1: Diagnostic medial branch blocks
- An anesthetic medication (i.e. lidocaine or bupivicaine) will be injected at the location of the medial branches. The anesthetic works fairly immediately. You will be provided a pain diary to track your response. If you notice a considerable improvement of your pain and function, it suggests the targeted joints are involved with your pain. The medication that was injected will eventually wear off.
Step 2 (ONLY if step 1 is successful; if step 1 does not help with your pain, other potential sources of your pain will be explored): repeat diagnostic medial branch blocks with a different anesthetic.
- It is the exact same procedure as step 1, but with the use of a different medication. It is essentially a confirmation test to ensure the targeted joints are involved with your pain.
Step 3 (ONLY if Step 1 and Step 2 are successful): You are a likely candidate for the treatment of your pain with a procedure called Radiofrequency Ablation (RFA).
- With the use of a special type of needle and probe, radio waves are used to generate heat to create a small lesion on the medial branches to block pain signals. The procedure can result in 6-12 months of pain relief. The reason why this procedure doesn’t last forever is because the medial branches can grow back. However, if successful, RFA can be repeated in the future.
- It is a well tolerated procedure with local anesthesia. Anecdotely, it is the numbing of the skin (which can cause a short-lived burning sensation) that bothers the patients the most during the procedure.
As mentioned above, all three steps are done under x-ray guidance. They are safe procedures, however is a small risk of infection and bleeding. Because of the small risk of bleeding leading to a catastrophic sequela, no blood thinners or anticoagulants need to be stopped for any of the procedures. With RFA, there is an additional small risk of nerve root injury (highway nerve that comes from the spine) and post-procedural neuritis (skin sensitivity/burning sensation).
Please note that insurance companies will allow 2 facet joints to be targeted per session (this could involve both the right and left side depending on the location of your symptoms).
Please watch the videos listed below to visualize and gain further understanding of the injections/procedure: