Medial Branch Block and Radio Frequency Ablation Procedures

June 6, 2022

Medial Branch Block (MBB) and radiofrequency ablations (RFA) are common interventional pain procedures that help alleviate pain for patients. It can be done in the neck, mid back, or low back.

What are medial branch blocks and radiofrequency ablations?
The back part of our spines contain specialized joints known as facet joints. Over time, from degenerate discs, accidents, trauma, instability, muscle weakness, etc. these joints become arthritic and can cause pain. Each joint is innervated by 2 nerves that are terminal branches from the spinal cord. These nerves are the medial branches.

During the medial branch block procedure, a physician will use image guidance to take a small needle to inject anesthetic agent (such as lidocaine or marcaine) to help block the pain signals. Per insurance guidelines, we consider this a diagnostic test.The patient is then asked to note and record how much pain relief they experience. The pain relief usually lasts only as long as the duration of the medication. If there is a “successful” test, then we will repeat this procedure 10-14 days later. If there is a second “successful” test, then the next step is usually a radio frequency ablation.

The RFA procedure is very similar, but instead of using anesthetic agents to block the nerves, we use the image guidance to place electrode needles right on top of the nerves causing the pain. Then after some trials to make sure we are on the correct nerves, we then turn on a machine that will send electrical impulses to burn the nerves. This is a much longer lasting solution compared to MBB, and we typically tell our patients 6 months to 2 years of relief, but everyone is different.

Can you clarify the protocol?
If deemed a good candidate for this procedure, the protocol is as follows:

Diagnostic Medial branch block #1 (record pain relief) → Discuss with practice pain relief→ repeat diagnostic medial branch block (record pain relief) → RFA one side → RFA the other side

Much of this is set by the insurance companies. The repeat of the diagnostic tests is to minimize false positive results. This increases the likelihood of a successful RFA procedure. Another thing to note, is insurance companies will only pay for 2 levels (3 nerves) at a time

Who are the best patients for this procedure?
Anyone experiencing low back pain that does not radiate or go down into the legs; neck pain that does not go into the arms; or mid back pain. Typically, we would want to see imaging that is consistent with arthritis of the facet joints as well. If this sounds like you, or you are experiencing other issues, set up an appointment to see what we can help you out with!


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