Medial Branch Block, Cervical Spine

KEY FACTS

Terminology

• Selective anesthesia of cervical nerve medial branch in diagnosis of cervical facet joint pain

Preprocedure

• Facet joint pain

  • Useful in selecting patients for medial branch radiofrequency ablation procedure

  • Need to block level above and below facet joint for effective anesthesia

Procedure

• Preferred patient position: Supine

• Preferred imaging plane: True lateral view

• C2/3: 3rd occipital nerve block

  • Target: Immediately above and below C2/3 facet joint

• C3/4-C6/7 MBB

  • Target: Midportion of articular pillar above and below facet joint

• C8 MBB

  • Target: Junction of superior articular process and T1 transverse process

Post Procedure

• Document pain before, during, and after injection

  • < 100% pain relief decreases likelihood of successful rhizotomy

• If corticosteroid injected, maximal benefit will be in 48-72 hours

Outcomes

• Possible problem: Failure of pain relief

• Complications

  • Stroke

  • Dural puncture: Spinal cord injury, CSF leak

  • Ataxia (upper cervical injections, particularly C2/3)

  • Phrenic nerve blockade (C3/4, C4/5, C5/6)

TERMINOLOGY