What is a Lumbar Medial Branch Block?

Lumbar medial branch blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Vertebral ColumnLumbar medial branch blocks are a common treatment approach that is used to treat and diagnose back pain as well as discomfort in the buttocks, hips, and groin. Several studies have reported that the degeneration and inflammation of facet joints causes between 10% and 15% of chronic back pain cases. It has also been reported, however, that a medial branch block effectively reduces inflammation in facet joints that is the result of irritated nerves.

Lumbar medial branch blocks are also an effective diagnostic technique. More specifically, if chronic pain rapidly ceases after this procedure is performed, then it indicates that facet joints were causing the pain. Furthermore, physicians can decide if additional block procedures, radiofrequency ablation therapy, or physical therapy should be recommended based on whether or not the patient positively responds to the initial medial branch block. This procedure destroys medial nerves and hinders pain transmission, which can lead to a long-lasting improvement in symptoms. 

How is a Lumbar Medial Branch Block Performed?

Preparation For ProcedureThis is a brief procedure that takes about 15 minutes. Before a physician begins, patients are asked to lie on the stomach and a disinfectant is used on the skin in order to prevent an infection. If sedation is necessary, than an IV containing an analgesic is used and the patient’s vital signs are monitored. An anesthetic may also be applied to the skin before the needle is injected.

While inserting the needle, the physician generally uses an imaging technique such as fluoroscopy to make sure it is positioned properly. Once the targeted region is confirmed with the use of a contrast dye, the steroid medication and an anesthetic are injected into the region where the affected facet joints are located. Patients usually report experiencing the benefits of this treatment a few days after receiving the injection.

Clinical trials have demonstrated the effectiveness of administering a medial branch block for the management of facet joint pain. According to these trials, combining an analgesic with steroid medication provides rapid and long-term relief for most back pain sufferers. Additional trials also emphasized the important role that lumbar medial branch blocks have in accurately diagnosing where a patient’s pain originated. Moreover, current medical standards recommend using a lumbar medial branch block in combination with an imaging evaluation in order to properly diagnose facet joint pain.

A lumbar medial branch block is a safe and non-invasive procedure, but it may still pose a few risks such as bleeding, nerve damage, facial flushing, infection, and insomnia.

Conditions Related To Lumbar Medial Branch Blocks

Lumbar BlockIf a physician recommends a facet block it usually means that facet joint degeneration has begun due to lumbar facet syndrome. Lumbar facet syndrome causes moderate or severe lower back pain that radiates into the hips and buttocks. Movements that cause the spine to become overextended, such as lifting heavy objects and repetitive movements, usually cause the pain to worsen, but a lumbar medial branch block can rapidly relieve pain.

A description of the anatomical structure of facet joints can also provide an explanation of the manner in which lumbar medial branch blocks function. Facet joints fit between vertebrae and provide support for the spine when the body bends or twists. A synovial fluid filled capsule also surrounds facet joints and acts as a protective cushion for these structures. Facet joints contain medial branch nerves that are involved in pain signal transmission from the lower regions of the body to the brain. A lumbar medial branch block has the ability to hinder this transmission and, in doing so, reduce pain.

Conclusion

A lumbar medial branch block is an effective treatment method for pain in the lower back, buttocks, hips, and groin. This procedure helps physicians accurately identify the pain source and can help improve a patient’s range of mobility, allow an individual to return to normal daily routines, and prevent back surgery. Each individual may experience a different length of relief, but a branch block may be repeated if necessary. Radiofrequency ablation therapy may also be performed to provide a patient with sustained relief.

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References

  1. Cohen S, Strassels S, Kurihara C, Forsythe A, Buckenmaier C, et al. Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology. 2010;112:144-152.
  2. Cohen S, Eaja S. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial(facet) joint pain. Anethesiology. 2007;106:591-614.
  3. Cohen S, Williams K, Hurihara C, Nguyen C, Shields C, et al. Diagnostic medial branch blocks before lumbar radiofrequency zygapophysial (facet) joint denervation. Anesthesiology. 2010;113:276-278.
  4. Lee C, Kim Y, Shin J, Nahm F, Lee H, et al. Intravascular injection in lumbar medial branch block: A prospective evaluation of 1433 injections. Anesthesia & Analgesia. 2008;106(4):1274-1278.
  5. Massaia S, Nano G, Mammucari M, Marcia S, Simonetti G. Medial branch neurotomy in low back pain. Neuoradiology. 2012;54:737-744.