Learning About Medial Branch Block and Neurotomy

What are medial branch block and neurotomy?

Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic (long-term) pain in the neck or back.

Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

Radiofrequency medial branch neurotomy is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to damage nerves in your neck or back so that they can no longer send pain messages to your brain.

Before your doctor knows if a neurotomy will help you, you will get a medial branch block to find out if certain nerves are the ones that are a source of your pain. You will need two separate visits to the outpatient center or hospital to have both procedures.

You will need someone to drive you home.

How is a medial branch block done?

The doctor will use a tiny needle to numb the skin where you will get the block. Then the doctor puts the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, the doctor injects medicine onto one or more nerves to make them numb.

If you get relief from your pain in the next 4 to 6 hours, it's a sign that those nerves may be contributing to your pain. The relief will last only a short time. You may then have a medial branch neurotomy at a later visit to try to get longer relief.

How is a medial branch neurotomy done?

The doctor will use a tiny needle to numb the skin where you will get the neurotomy. Then the doctor puts the neurotomy needle into the numbed area. You may feel some pressure. Using fluoroscopy (live X-ray) to guide the needle, the doctor sends radio waves through the needle to the nerve for 60 to 90 seconds. The radio waves heat the nerve, which damages it. The doctor may do this several times. And more than one nerve may be treated.

How long do medial branch block and neurotomy take?

It takes 20 to 30 minutes to get the block. You can go home after the doctor watches you for about an hour.

It takes 45 to 90 minutes to get a neurotomy, depending on how many nerves are heated. You will probably go home 30 to 60 minutes after the procedure.

What can you expect after a neurotomy?

You will get instructions on how to report how much pain you have when you are at home.

You may feel a little sore or tender at the injection site at first. But after a successful neurotomy, most people have pain relief right away. It often lasts for several months, but your pain may come back.

If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.