Cervical Medial Branch Block

What are medial branch block and radiofrequency ablation?

Just like shoulders and knees, your back is connected by many joints, called facet joints. Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic pain in the neck or back. They can also sometimes affect the shoulders, arms, buttocks, or legs.

Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

Radiofrequency ablation of the medial branch is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to numb the nerves in your neck or back so that they can no longer send pain messages to your brain.

Before your doctor knows if a radiofrequency ablation will help you, they will do two medial branch blocks to find out if certain nerves are the ones that are a source of your pain. You will need three separate visits to have two medial branch blocks for diagnosis, and one radiofrequency ablation as the definitive treatment for your pain.

How is a medial branch block done?

The doctor will use a tiny needle to numb the skin with lidocaine where you will get the block. Then they put the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, we inject medicine onto one or more nerves to make them numb.

If you get relief from your pain in the next few hours, it’s a sign that those nerves may be contributing to your pain. The relief will last only a short time. We will do a short follow up visit to discuss whether you received adequate relief and decide on the next step. If you received significant relief, we will repeat the diagnostic block 2 weeks later. Please inform your physician how much pain relief you had from the procedure so that it can be documented and proceed with the radiofrequency ablation if indicated. 

If you received significant relief from both blocks, you may then have a medial branch radiofrequency ablation at a later visit to try to get longer relief. The radiofrequency ablation typically gives relief between 6 months to 1 year. It can then repeated as needed in the future for continued relief. It takes 10 to 20 minutes to get the medial branch block. You can usually go back home soon after the block. We will do a short follow up visit to discuss whether you received adequate relief and decide on the next step. You will need someone to drive you home.

How is medial branch radiofrequency ablation done?

The doctor will use a tiny needle to numb the skin where you will get the radiofrequency ablation. Then they would put the radiofrequency needle into the numbed area. You may feel some pressure. Using fluoroscopy (live X-ray) to guide the needle, the doctor sends electricity through the needle to the nerve for 60 to 90 seconds. The electricity heats the nerve, which silences it. The doctor may do this several times, and they may treat more than one nerve.

It takes 20 to 30 minutes to get a radiofrequency ablation, depending on how many nerves are ablated. You will need someone to drive you home.

What can you expect after a radiofrequency ablation?

You may feel a little sore or tender at the injection site at first. You may also feel sore at the ablation site for 1-2 weeks. However, after a successful radiofrequency ablation, most people have pain relief right away. It often lasts for 6 months or longer. Sometimes the pain relief is permanent.

If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Figure 1: Just like shoulder joint pain, the neck joints are the most common cause of neck pain. May it be for whiplash from car accidents, arthritis, or simply sleeping wrong waking up with a terrible neck pain. These are small tiny joints called the facet joints (in red).

The pain from these joints are communicated by small branches of nerves called medial branch nerves (arrows). Treatment of these joint pain involves blocking (medial branch block) and potentially silencing (radiofrequency ablation) for more prolonged relief. This is an effective non-surgical treatment, and it only involves flu-shot-sized needles (size of the needle in the image is the size of an actual needle).

Figure 2 and 3: Cervical medial branch radiofrequency ablation. This is a common interventional pain treatment for neck pain mediated by the cervical facet joint. The third occipital nerve depicted in the image is also commonly implicated in headache, with pain referral pattern to the eyes, forehead, jaw and back of the head. Facet-mediated pain is first diagnosed with cervical medial branch block, which is injecting numbing medicine at the medial branch nerves.

If the pain is relieved, then facet-mediated pain is diagnosed. Radiofrequency ablation can then be used to silence these nerves. The treatment typically provides 0.5-1year of pain relief and it can be repeated as needed. Many headaches have a component in cervical faceted-mediated pain, and cervical medial branch block should be considered as part of the diagnostic workup of headache.