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). Each joint is supplied by two small nerves called medial branches. In order to assess if a joint is causing pain, Dr. Garala would need to block those two nerves supplying the sensation for that joint. However, Dr. Garala may decide to block a few joints (on one side or both sides of the spine) depending on the pain symptoms. This procedure is called diagnostic medial branch blocks. Dr. Garala blocks the nerves using an anesthetic to determine if that is the source of the pain. If successful, the patient will feel pain relief. Dr. Garala will ask for the patient to document their response in a pain diary (will be handed to the patient on the day of the injection) based on positions and/or activities that typically bother them. It is extremely important to perform provoking positions/activities soon after injections so Dr. Garala can truly assess if the injections are helpful for the pain. If Dr. Garala believes the injections were successful, he will recommend a second set of diagnostic injections to validate pain relief. The patient will once again be asked to record their responses in a pain diary based on exacerbating positions and activities. Two sets of injections are typically needed to ensure a more accurate diagnosis of the cause of the pain.
If Dr. Garala believes the responses to the two sets of diagnostic medial branch blocks were successful, it increases the predictive value that the patient might be a successful candidate for the treatment procedure called radiofrequency neurotomy. This procedure actually burns the small nerves providing longer pain relief, up to a year. Radiofrequency ablation can be repeated in the future if there is a recurrence or worsening of pain.
Please watch the animation videos listed below to visualize and gain further understanding of the injections/procedure:
Diagnostic Medial Branch Blocks