A cervical medial branch block is a simple procedure for diagnosing and treating headaches, neck, shoulder, and upper back pain.  

What are cervical facet joints?

Facet joints connect to the vertebrae, the bones of the spine.  They help guide your spine when you move.  The neck area of the spine is called the cervical region.  It contains seven vertebrae.  Facet joints are found on both sides of the spine.  Each is about the size of a thumbnail.  Cervical facet joints are named for the vertebrae they connect and the side of the spine where they are found.  Medial branch nerves are found near facet joints to your brain.

What is cervical facet joint pain?

You may feel pain if a cervical facet joint is injured.  Sometimes it feels like simple muscle tension, other times it can be severe pain.  The cartilage inside the joint may be injured.  Other times only connecting ligaments surrounding the joint are injured.  Facet pain also depends on which facet joint is affected.  Pain from cervical facet joints occurs in an area from your head down to your shoulder blade.  

How do I know if I have cervical facet pain?

If you have pain in one or more of these areas, and it persists longer than two months, you may have cervical facet pain.  Common tests such as x-rays or MRIs may not show if a facet joint is causing pain.

What is a cervical medial branch block?

A cervical branch block, an anesthetic is injected near the medial branch nerve.  This stops the transmission of pain signals from the facet joint.  If this reduces your pain and helps you to move you neck like normal, it tells your physician which facet joint is causing your pain.

What happens before treatment? 

The doctor who will perform the injection will review your medical records and imaging studies to plan for the best location for these injections. Patients who are taking aspirin or blood thinners may need to stop taking them several days before epidural steroid injection, doctor will provide specific instructions. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection. The injection is usually performed in an outpatient procedures suite that has access to fluoroscopy. You will need make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

What happens during treatment? 

Before your injection, you will be asked to sign consent forms, list medications you are taking, and list any allergies to medications. Procedure may last 15-30 minutes followed by a recovery period. Patients remain awake for these procedures. Sedatives can be given to help lessen anxiety.  The patient will be lying face down on the table, will receive a local anesthetic, which will numb the skin before the injection is given. If IV sedation is used, your blood pressure, heart rate and breathing will be monitored during the procedure.  With the aid of a fluoroscope (a special X-ray), the doctor will direct a hollow needle through the skin and muscles of your neck next to facet nerves (medial branch nerves). Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes into correct location. Contrast agent may be injected to confirm correct needle position and desired medication spread. Some discomfort may occur, but patients typically feel more pressure than pain.  After the needles are confirmed to be in correct position, the doctor will inject long acting corticosteroid medication into your cervical facet joints or next to the facet nerves. Needles are then removed. 

What happens after treatment? 

Most patients can walk immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home. Typically patients will resume full activity the next day. If soreness around the injection site is present the following day, it may be relieved by using ice and taking mild pain medications such as Tylenol. The doctor’s office may want to follow up with you 7 to 14 days after the procedure to assess you response to this injection. You may be provided a diary to record you response to this procedure. You may notice a slight increase in pain after the numbing medicine wears off and before the corticosteroid medication starts to take effect. If facets are the source of pain, you may begin to notice pain improvement in two to five days after the injection.  If you experience no or a little pain relief, then it is unlikely that you will benefit from more injections. Additional diagnostic tests may be needed to accurately diagnose your pain. If you experience recurrence of your neck pain after a short period of time and you’ve experienced good pain relief with the facet nerve blocks, you may be a candidate for a procedure that uses a radiofrequency probe to destroy some of the nerve fibers causing pain and produce longer duration pain improvement - radiofrequency rhizotomy.

What are the risks?

 The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare), corticosteroid medication induced side effects such as weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These usually resolve within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, or those who cannot temporarily discontinue anti-clotting medication) should consult their personal physician for a risk assessment.  With few risks, epidural steriod injections are considered an appropriate nonsurgical treatment for some patients.

How long can I expect pain relief?

The length of time you can expect pain relief depends on how many areas are injured, and on the amount of inflammation you have.  If your pain goes away for a short time, but returns, you may be a candidate for radiofrequency ablation (RFA) to the medial branch nerve.  This procedure provides a more permanent disruption of pain signals.