Chapter 8 Medial Branch Block and Radiofrequency Lesioning
Treatment objectives
Medial Branch Block
The treatment objectives are to diagnose and treat facet joint syndrome. Facet joints are one of the most common sources of back pain. Facet joint syndrome cannot be diagnosed clinically or radiographically but can be identified with MBB or facet joint injection [1–5]. A series (3-5 times) of local anesthetic injections with or without corticosteroids sometimes achieves long-term relief of back pain.
Radiofrequency Neuromodulation (Pulsed Radiofrequency Lesioning) or Neuroablation (Radiofrequency Thermocoagulation) of the Medial Branch
The treatment objective of radiofrequency lesioning is to treat facet joint syndrome. This procedure offers pain relief by modulating (pulsed radiofrequency lesioning [PRFL]) or denaturing (radiofrequency thermocoagulation [RFTC]) medial branches that innervate the painful facet joints. The typical durations of pain relief experienced after such procedures are as follows [6]:
Preoperative preparation
History Taking and Physical Examination
Figure 8–7 A composite map shows pain referral patterns from the T3-T4 to the T10-T11 thoracic facet joints.
(Modified from Dreyfuss P, Tibiletti C, Dreyer S: Thoracic zygapophyseal joint pain patterns. Spine 1994:19;807-811.)
Indications
Medial Branch Block
Indications for MBB in the cervical spine include the following:
Indications for MBB in the thoracic spine include the following:
Indications for MBB in the lumbar spine include the following:
Contraindications
Contraindications to MBB, PRFL, and RFTC are as follows:
Complications
Anatomy
At each level, facet joint innervation is derived from the medial branch of the adjacent spinal nerve, as well as the medial branches located one level above and perhaps one level below. Figures 8-10 through 8-12 show facet joint innervation of the three regions of the spine.