Medial Branch Block, Thoracic Spine

KEY FACTS

Terminology

• Selective anesthesia of thoracic spinal nerve medial branch in assessment of thoracic facet joint pain

Preprocedure

• Thoracic facet joint pain

  • Confirm clinical suspicion (diagnostic)

  • Evaluate likelihood of successful facet neurolysis

• Preprocedure imaging

Procedure

• Target

  • Immediately above transverse process/superior articular process junction

    • –

      Be sure to avoid lung

  • Carefully approach medial branch as close as possible to lateral aspect of superior articular process

• Record pain score

  • Before, during, and after injection for each level

Post Procedure

• Expected outcome: Significant reduction in pain associated with target facet joint

  • < 100% pain reduction reduces likelihood of successful neurolysis

Outcomes

• Problem: Failure of pain reduction

  • Facet joints not sole pain generator

  • Inaccurate needle placement

• Complications

  • Vasovagal reaction

  • Pneumothorax

  • Spinal/nerve cord injury

• Alternative procedures

  • Physical therapy

  • Neurolysis

  • Thoracic facet joint injection(s)

TERMINOLOGY