Medial Branch Blockade – the Double-Block Paradigm

///Medial Branch Blockade – the Double-Block Paradigm

Neck and Spinal X-RayChronic neck and back pain unfortunately are common conditions which negatively affect quality of life. People who suffer from these chronic conditions frequently despair at their inability to enjoy their favorite pastimes and inability to work or be as productive as usual. The have usually been seen by numerous medical or chiropractic physicians and have had treatments including manipulation, physical therapy, medications, injections, or even surgery.

In these cases, it is important that the exact cause of their pain is determined so that appropriate treatment recommendations can be made. Although diagnostic testing such as MRI may provide useful information, in almost all cases, an MRI is incapable of determining the exact cause of the pain or so called pain generator.

A Common Cause of Low Back & Neck Pain

A common cause of low back, and especially neck pain, are the facets or, more appropriately termed, zygapophyseal joints. Two of these zygapophyseal joints are present at each disc level throughout the spine. These joints, like other joints in the body such as the knee or shoulder, can become arthritic, injured, or painful. However, unlike these other joints, they cannot be surgically replaced. Additionally, cortisone or steroid injections into these joints has been shown to be ineffective in the treatment of these painful joints.

What is Medial Branch Blockade?

Scientific research has demonstrated that the only reliable and valid way to determine if the zygapophyseal joint is painful is by medial branch blockade. The medial branches refer to smaller nerve branches which come off of the larger nerves exiting the spine. These nerves go to the zygapophyseal joints. They also serve other functions such as sensation to the overlying skin and to the deeper muscles surrounding the spine. When the zygapophyseal joints are painful, these medial branches transmit the pain nerve impulse, which ultimately reaches our brain through the spinal cord letting us know that our back or neck hurts.

By anesthetizing or numbing these medial branches, we can determine if the targeted zygapophyseal joint is painful. The performance of a medial branch blockade takes highly specialized skill and x-ray or fluoroscopic guidance. The person being tested must have the pain prior to the medial branch nerve block so that it can be determined if there is pain relief after the block. Due to the placebo response, the response to the medial branch block must be repeated on at least one other occasion to be confident in the diagnosis of zygapophyseal joint pain.

Effective, Validated Non-Surgical Treatments

If one or more zygapophyseal joints are determined to be the cause of pain, there are very effective scientifically validated non-surgical treatments for the treatment of the pain.

This treatment is known as radiofrequency neurotomy.

If you suffer from chronic neck, back, or joint pain and may benefit from this procedure, please contact us at (610) 954-9400 regarding the radiofrequency (RF) neurotomy or schedule an appointment with the doctor.

We are committed to improving your life without a knife.

We encourage setting up your doctor's appointment with Dr Scott Naftulin and Specialty Spine, Sports & Pain at the Bethlehem Spinal Care Treatment Center by completing the On-Line Appointment Scheduler. You may also contact us by calling (610) 954-9400 to arrange a visit to the doctor.

About the Author:

Dr. Scott Naftulin received his Bachelor of Science Degree from Ursinus College and his Medical Degree from Philadelphia College of Osteopathic Medicine. He is board certified by the American Board of Physical Medicine and Rehabilitation with a sub-specialty in Pain Medicine. Dr. Naftulin received specialized training in interventional pain management and performs a variety of diagnostic, therapeutic and image-guided procedures.