MEDIAL BRANCH BLOCKS (MBB)

FREQUENTLY ASKED QUESTIONS

What are the Spinal Facet Joints?

What are the Medial Branch Nerves?

What are Medial Branch Blocks (MBBs)?

Are Medial Branch Blocks Painful?

Can I be put to “Sleep” for an MBB?

Can I have any Sedation for an MBB?

Are there any Risks with IV Sedation?

Will an MBB make all my Pain go Away?

How Long until the MBB Starts to Work?

How Long will Pain Relief last after an MBB?

How many MBBs will I need?

What if the MBB does not Help my Pain?

What are the Risks of an MBB?

What are the Side Effects of Steroids?

Do I Need to Stop any Medication for the MBB?

What Happens on the Day of the MBB?

What Happens After the MBB?

 

 

What are the Spinal Facet Joints?

  • Spinal facet joints are a pair of joints on the posterior aspect (back side) of the spine.

  • These small joints assist in the movement and stability of the spine.

  • These joints can also be a source of pain in the neck/back.

 

What are the Medial Branch Nerves?

  • Medial Branch Nerves are the small nerves that “supply” the spinal facet joints.

  • Any pain signal from an arthritic facet joint must first travel through these nerves.

 

What are Medial Branch Blocks (MBBs)?

  • Spinal Facet Joint Arthritis is considered a normal aspect of aging.

    • As a result, imaging studies (X-Rays, MRIs, CT Scans) often show facet joint arthritis.

    • However, facet joint arthritis does not always cause pain.

  • MBBs are a DIAGNOSTIC PROCEDURE to determine if the facet joints are causing pain.

    • MBBs involve injecting numbing (anesthetic) medication onto the medial branch nerves.

    • Goal: Temporarily “block” any pain signals coming from the facet joints

  • Two possible outcomes from an MBB

    • Outcome 1: Typical Spine Pain improves significantly after the MBB

      • Conclusion: Pain is coming from the facet joints

    • Outcome 2: Typical Spine Pain does not improve significantly after the MBB

      • Conclusion: Pain is not coming from the facet joints.

  • If MBBs help, a radiofrequency ablation can be performed to burn the medial branch nerves.

    • See Radiofrequency Ablation (RFA) for more details regarding this procedure.

  • If the MBB does not help, an RFA procedure will not provide any benefit.

    • Your provider will discuss other treatment options to help your pain.

Are Medial Branch Blocks Painful?

  • Most individuals tolerate MBBs well with little discomfort.

  • If any discomfort is felt, it is usually short-lived and tolerable.

  • If you feel any significant discomfort during the procedure, tell your doctor.

 

Can I be put to “Sleep” for an MBB?

  • Stone Med DOES NOT recommend general anesthesia for any spinal procedure.

  • Risk of complications increases if an individual is “put to sleep”.

 

Can I have any Type of Sedation for an MBB?

  • Individuals may choose to have “light” IV sedation for their injection.

  • Light sedation is not designed to put you completely to sleep.

  • Goal of Sedation: Reduce anxiety enough to make the procedure more comfortable

  • Decision to have sedation is up to the individual having the procedure, not the doctor.

 

Are there any Risks with IV Sedation?

  • IV sedation increases the risk of nausea and vomiting during the procedure.

  • Vomiting while sedated may cause you to aspirate (inhale) some vomit into your lungs.

    • Could cause a serious pneumonia, requiring antibiotics and possible hospitalization.

  • Risk of aspiration is significantly reduced if you do not eat or drink prior to the procedure.

    • Do not eat for 6 hours prior to the procedure.​

    • Do not drink for 4 hours prior to the procedure.

 

Will an MBB make all my Pain go Away?

  • Goal: Reduction of typical pain by at least 80% during the testing period.

    • There should be an obvious, significant improvement in pain and function.

  • While it is possible to obtain complete pain relief after an MBB, this is not always possible.

 

How Long until the MBB Starts to Work?

  • Pain relief after an MBB occurs about 5-30 minutes after the block is completed.

 

How Long will Pain Relief last after an MBB?

  • Unfortunately, pain relief experienced with an MBB is temporary, lasting about 4-6 hours.

  • Once the numbing medicine wears off, pain often returns to pre-injection levels.

    • This is the NORMAL and EXPECTED response.

  • If you experienced pain relief, even if temporary, the MBB was successful.

  • Return of pain several hours after the injection does not signify a failed injection.

  • Radiofrequency Ablation (RFA) provide the long-term treatment of facet joint pain.

 

How many MBBs will I need?

  • Insurance companies require TWO successful MBBs to qualify for a radiofrequency ablation.

    • The two MBBs must be performed on different days.

  • If the first MBB provides benefit, a second MBB is performed to confirm this response.

    • If the second MBB provides benefit, a radiofrequency ablation can then be performed.

  • If the first MBB does not provide benefit, there is no need to undergo a second MBB.

    • In this situation, burning the nerves will not help pain not from the facet joints.

 

What if the MBB does not Help my Pain?

  • If the MBB does not provide pain reduction, the facet joints are not likely the source of pain.

    • Burning the nerves will not help pain that is not coming from the facet joints.

  • A negative MBB procedure provides very valuable information to your physician.

    • A negative MBB rules out the facet joints as a cause of pain.

    • Your provider can focus on treating other possible sources causing your pain.

 

What are the Risks of an MBB?

  • All injections have possible risks, side effects, and complications.

    • When performed correctly, all the following risks are rare.

PAIN

  • MBBs usually do not cause significant discomfort during or after the procedure.

  • Any increased discomfort usually lasts less than 24 hours.

BRUISING

  • Superficial bruises resolve without any specific treatment.

  • More common in older individuals and those taking blood thinning medications.

INFECTION

  • Minimal risk, as we thoroughly clean the skin prior to every injection.

  • All needles are brand new (never reused) and opened just prior to the injection.

BLEEDING

  • Excessive bleeding is rare, even if the needle hits a deeper blood vessel near the spine.

    • Any bleeding usually stops on its own without complications.

  • Risk of Bleeding increases if:

    • You have a genetic bleeding disorder.

    • You are taking medications that thin your blood.

NERVE DAMAGE, PARALYSIS

  • Very Rare Complications

  • Direct Nerve Trauma from the Needle is very unlikely.

    • Risk is higher if the patient is “put to sleep” for the injection.

  • Damage to the anterior spinal artery could result in a spinal cord injury.

    • This artery supplies blood to the front of the spinal cord.

    • Contrast is injected to ensure the needle is not in a major artery.

SEIZURES, DEATH

  • Exceptionally Rare Complications

  • Even if all precautions are taken, these severe complications are never reduced to zero.

 

What are the Side Effects of Steroids?

  • Steroid medications are not used during MBB procedures.

 

Do I Need to Stop any Medication for the MBB?

Blood Thinning Medications

  • Blood thinners are often stopped about 3-7 days prior to spinal injections.

  • Tell your provider if you are taking any blood thinning medications.

    • Examples: Coumadin (Warfarin), Pradaxa, Eliquis, Xarelto, Plavix, Aspirin, etc.

  • These medications are usually prescribed for serious medical conditions.

    • We will contact your prescribing doctor to ensure it is safe to temporarily stop these medications for your procedure.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

  • NSAIDs are often stopped about 5-7 days prior to spinal injections.

    • These medications can increase your risk of bleeding.

  • Tell your provider if you are taking any NSAIDs.

    • Examples: Ibuprofen (Advil, Motrin), Naproxyn (Aleve, Naprosyn), Indocin (Indomethacin), Lodine (Etodolac), Relafen (Nabumetone), Meloxicam (Mobic), Diclofenac (Voltaren), etc.

  • Celebrex (Celecoxib) is an NSAID that does not significantly increase the risk of bleeding.

    • Celebrex does not have to be stopped prior to spinal injections.

Supplements

  • Many natural supplements can affect clotting pathways, increasing the risk of bleeding.

  • For safety, please stop taking supplements for at least 5 days prior to your injection.

    • Examples: Fish Oil, Vitamin E, Ginko Biloba, Ginseng, Garlic, St. John’s Wort

Other Medications

  • Do not stop taking any medications unless you are specifically told to stop.

  • If you have any questions about taking a certain medication, ask your provider.

 

What Happens on the Day of the MBB?

Where do I go?

  • All MBBs are performed in an outpatient ambulatory surgery center.

  • The address and phone number of the surgical center will be provided to you.

When Should I Arrive?

  • Please arrive at least 15 minutes prior to your appointment to get checked in.

How Long will the Procedure Take?

  • Expect your appointment to last around one hour from arrival to discharge.

Should I Take my Blood Pressure Medications on the Morning of the Procedure?

  • Yes; these medications do not thin your blood. Take them always.

Can I Eat or Drink prior to the Procedure?

  • If you are not having Sedation, you can eat and drink before the procedure.

  • If you want Sedation:

    • Do not eat for 6 hours prior to your injection.

    • Do not drink for 4 hours prior to your injection.

      • You may take your medications with small sips of water.

Can I Drive Myself to the Procedure?

  • If you are not having Sedation, you may drive yourself or use a Taxi/Uber/Lyft service.

  • If you are having Sedation, you MUST have an adult over 18 years old to drive you home.

    • You cannot use a Taxi/Uber/Lyft service unless you have an adult with you.

    • Your driver must remain at the surgery center throughout the entire procedure.

      • Your driver is not allowed to leave and come back later to pick you up.

      • Individuals have been left at the surgery center with no way home (sad but true).

What Happens After the MBB?

ACTIVITY

  • On the day of the injection, you should perform activities that normally cause your pain.

  • Goal: To see if these normally painful activities still cause pain after the joints are numb

TESTING PERIOD/PAIN DIARY

  • You will need to record your pain scores throughout the day after the MBB.

  • Needed to determine exactly how much improvement you got during the testing period.

    • Accurate recording of pain levels in a diary is a VERY IMPORTANT.

    • This documentation is needed to get the RFA procedure approved.

PAIN MEDICATIONS

  • DO NOT TAKE PAIN MEDICATION OF ANY KIND during the testing period.

    • The Testing Period lasts for about 6-8 hours after the MBB.

    • This is the amount of time that the numbing medication is expected to last.

    • The only pain reduction should be from the anesthetic medications, not pain pills.

  • After the testing period ends, you may resume your normal pain medications.

OTHER MEDICATIONS

  • You may resume NSAIDs, Aspirin and other blood thinners the following morning.

EATING/DRINKING

  • You may eat and drink immediately after your injection is finished.

WATER/BATHS/SHOWER

  • You may shower the evening of your procedure, if desired.

  • Avoid submerging the injection site under water for 24 hours to reduce any risk of infection.

    • No Baths, No Swimming Pools, No Hot Tubs, etc.

CALL YOUR DOCTOR IF YOU DEVELOP ANY OF THE FOLLOWING:

  • Fever/Chills

  • Drainage/Other Signs of Infection

  • Excessive Swelling or Redness at the Injection Site

  • New/Worsening Severe Pain

  • New/Worsening Bowel/Bladder Dysfunction

  • New/Worsening Numbness/Weakness

  • New Headache that does not Resolve on its own

FOLLOW UP

  • You may follow up as soon as possible after the MBB procedure to discuss the results.

  • If you have not made a follow up, please call the Stone Med office to set up this appointment.