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What is a Medial Branch?

Medial branch nerves are the very small nerve branches that carry pain signals from the facet joint to the spinal cord. These signals eventually reach the brain where pain is noticed.

What is a Medial Branch Block and Radiofrequency (RF) neurotomy?

If a patient has received significant pain relief from a facet joint injection, they are candidates to have a medial branch block to determine if a more permanent form of blocking these nerves would be beneficial. If pain is relieved with these "test blocks" a patient is a good candidate for a RF neurotomy procedure. The ultimate goal is to cauterize or temporarily destroy the medial branches. This is achieved using heat from a special needle so pain from the joint can longer be felt.

What happens during the procedure?

The medial branch blocks generally take 15 — 30 minutes depending on the number of levels being injected. With both procedures you will lie on your stomach and after cleansing the area with an antiseptic, a local anesthetic will be administered. Using x-ray guidance (fluoroscopy), the radiologist will direct a small needle to the medial branches. A small amount of x-ray contrast (dye) will be injected at each site to ensure proper needle placement. With medial branch blocks a small amount of local anesthetic will be injected.

The RF neurotomy generally takes 1 hour. A special needle is placed at each medial branch and heated using an electric current. During the procedure the needles will often be gently stimulated using the electrical current to ensure safe positioning prior to cauterizing the nerve. Often a small amount of corticosteroid will be deposited at each neurotomy site following the procedure.

Does Health Care or Insurance cover this procedure?

Alberta Health Care will cover the cost involved with this procedure. The Workers Compensation Board may also cover this procedure if you have a claim number.

Pre-injection instructions

  • There is no restriction to your diet
  • You will need someone to drive you home
  • Please reduce any pain medication (Advil, Tylenol, etc.) the day of your appointment, so that you have enough discomfort (but not extreme) to determine if your procedure has been effective in relieving your symptoms. If you are in pain despite your medications, you do not need to decrease them. Please do not stop any pain medication that has been prescribed by your doctor without consulting him or her first. For a RF neurotomy you may continue to take your pain medications as usual
  • Inform your doctor and the radiologist if you are allergic to iodine, contrast material or dye, are diabetic or taking anti-coagulants
  • If you are taking anti-coagulants, you must discontinue use of them 5-7 days prior to your appointment. You will also be required to have a "STAT" INR blood test done the day prior to your procedure

Post injection instructions

  • After your procedure you will be required to remain in the radiology department for approximately 30 minutes to "rate you pain" post injection
  • You will be given a pain diary to take home to document your pain levels associated specifically with the treated area
  • You may resume normal activities as tolerated after the procedure. Unless there are complications, you should be able to return to work the same day
  • It is recommended that you follow up with your referring physician and physiotherapist

Are there risks?

Generally this procedure is safe, however with any procedure there are risks, side effects and the possibility of complications. Very rarely you may experience local bleeding or infection in or around the injection site. Rarely, local anesthetic may spread to a nearby nerve root and cause temporary weakness and numbness or a patient may have an adverse reaction to the contrast material (x-ray dye) used. In the upper cervical spine, a temporary feeling of imbalance or vertigo often occurs, but this is short-lived.

In the neck of the spine some patients may develop an area of altered sensation in the skin over the area being treated for a RF neurotomy. Uncommonly, the pain may be temporarily increased for approximately 2-4 weeks following a RF neurotomy from the nerve being irritated.

If you feel you may be a candidate for this procedure, speak with your family physician about a referral or arrange for a consultation with an Evidence Sport and Spine physiotherapist at the Advanced Spinal Care Centre for an evaluation.

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