Interventional Spine Therapies: medial branch block, radiofrequency ablation, and axial injections

Interventional spine therapies can be an alternative to pain pills. Patients struggling with chronic back and neck pain have been treated for years with narcotic medications. These medications include morphine, codeine, hydrocodone, oxycodone and methadone. Patients can develop tolerance to these narcotic pain medications, requiring higher and higher doses to achieve the same effect. Narcotic agents bind pain-mediating receptors throughout the body and influence pain pathways in the brain. However, they have significant systemic side effects ranging from itching and constipation all the way to respiratory depression.  The risk of sudden death increases with increasing doses of these medications.

In a New York Times interview, reporter Barry Meier notes, “it’s clear that the long-term use of these drugs can not only be ineffective for chronic pain, but they also create bad side effects for patients. Not just addiction but powerful psychological dependency, depression of hormone production, lethargy and listlessness and sleep apnea, among others. These drugs do work well for some patients, but for many other patients, they’re not working well at all.”

Patients wishing to avoid these potential find alternative means of relief through interventional spine therapies.

Medial Branch Nerve Block

Medial branches are nerve branches that supply the facet joints in the spine, mediating pain signals from those joints.  The facet joints are the joints between the vertebrae that contribute to motion and stability of the spine. A medial branch nerve block uses cortisone and a numbing medication to interrupts the pain signal being carried from a specific facet joint.

Radiofrequency Ablation

If the medial branch nerve block proves successful but only provides temporary relief, radiofrequency ablation is an additional option that uses heat to burn the medial branch.  The nerve does regrow overtime, but if successful this procedure provides relief for 6 months to 1 year, sometimes longer.  This minimally-invasive procedure can be performed in-office with a local anesthetic and a fluoroscopic (X-ray) machine.

Facet Joint Injections

A minimally invasive procedure, facet injection is used to temporarily relieve pain caused by inflamed facet joints. The procedure has two purposes: as a diagnostic test to see if the pain is actually coming from facet joints and as a treatment to relieve inflammation and pain caused by various spine conditions. The goal is to reduce pain and in conjunction with physical therapy, restore function. Facet injections are typically done in the cervical and lumbar spine.

Epidural Steroid Injections

This outpatient procedure uses a combination of a corticosteroid— strong anti-inflammatory medicine—with a local anesthetic pain relief medication.  Decreasing swelling and inflammation can take pressure off nerves and other soft tissues, which can relieve pain. The local anesthetic medicine helps give immediate pain relief. Corticosteroid medicines take longer to have an effect. These injections, like all procedures mentioned here, are performed under fluoroscopy to ensure proper placement of the medication.