Facet Blocks: Medial Branch


 

The facet (zygapophyseal) joints contain nerves which transmit pain back to the spinal cord.  These are called medial branches of the primary posterior (dorsal) ramus, or just medial branches for obvious reasons.  

They are small nerves that have a predictable course.  Instead of blocking the facets inside the joint, it is possible to perform a diagnostic-only injection of the medial branches going to the joint. 

By blocking the descending and ascending branches, the joints do not transmit any pain while blocked.  Injections of the medial branches are always diagnostic and never therapeutic.  The effect is expected to last a maximum of 6-12 hours. 

These injections performed under fluoroscopy, are a prelude to further therapeutic injections or longer lasting neuroablative procedures such as RadioFrequency Ablation, laser, or cryoneurolysis of the medial branches.  Medial branch blocks have an advantage over intra-articular facet blocks in that there is little chance of spillage of local anesthetic onto other sensitive structures. 

These blocks may be performed with or without sedation. 

Complications from such a procedure are very rare due to the fact the bone itself is used as a target.

 

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