The facets are the little joints that connect one spine of the vertebra to the other at the back of the spinal cord. Each vertebral portion has two facet joints, one on each side. Now we can discuss the Thoracic medial branch block.
The cervical facet joints guide movement in the neck, and the thoracic facet joints guide movement in the mid-back.
These joints provide structural stability to the body and control, in addition to movement in the spine, with the goal that you can curve and bend.
The area of the spine between the neck and the lower back is known as the thoracic region. The nerves that supply these facet joints are known as the medial branch nerves.
The pain from the thoracic joints is felt mostly in the middle back.
What is Thoracic Medial Branch Block?
The thoracic medial branch block is a procedure used to diagnose if the pain a patient is feeling at his/her middle back is coming from the facet joints.
The procedure is done by injecting a numbing medicine (local anesthetic) into the medial branch nerves that are responsible for transmitting pains from the facet joints to the brain.
If the patient feels relieved from the pain after the procedure, then the doctor will know the nerve transmitting the pain and the cause of the pain.
If the cause of the pain has been diagnosed, then the doctor may permanently help reduce or stop the pain using a procedure known as radiofrequency neurotomy.
Medial branch block is a temporary procedure to reduce thoracic pain before a more permanent procedure known as radiofrequency neurotomy is carried out to permanently bridge or stop the transmission of pain signals to the brain.
How do know if you have thoracic facet joint pain
Pains from the thoracic joints occur mostly from the upper part of the back through to the shoulder and down to the hips. If your thoracic joint is injured, you may feel pain.
The pain could be mild such as muscle tension or it could be severe. You may also feel pain when the cartilage inside your joint is injured or when the ligaments surrounding the joint are injured.
Who is the right candidate to undergo this procedure?
You are not the right candidate for this procedure if:
- You are allergic to any of the medications that will be injected.
- You are on a blood-thinning medication.
- You have an infection.
- You have a bleeding problem.
Before the Procedure
Before you undergo the procedure, you should talk to your doctor first. Inform your doctor about any medical condition you may have, your medical history, previous diseases or infections and any current medications you are taking.
In the event that you are on NSAIDs drugs, you should quit taking them. Do not eat or drink anything 2 hours before the system. Wash up with sedated soup before coming and wear a free dress. Be at the medical clinic or hospital 30 minutes before the commencement of the procedure.
During the Procedure
The doctor will ask you to lie down on your stomach on an examination table while resting your head and arms in positions. Your blood pressure and oxygenation will be monitored. The skin at the area for the injection will be thoroughly cleaned and a local anesthetic will be used to numb the skin.
A thin needle is then inserted near the medial branch nerve. A fluoroscope is used to ensure that the needle is properly placed in the right position. A contrast dye may be injected so that the doctor can see clearly the position of the needle.
After the doctor has seen that the needle is placed in the right position, a small amount of numbing medication (anesthetic) is injected on to each targeted nerve.
After the Procedure
After the injection has been given, you will be monitored for about 30 minutes. You will be given a pain diary and discharge instructions. You need to follow all the instructions and record any improvements in the pain dairy.
You may feel immediate pain relief or numbness at your upper back region for some time after the injection has been administered. This is due to the effect of the local anesthetic that was given and the relieve may last for few hours or few days.
This diagnostic test typically lasts for a few hours or some days before a more long-lasting pain-relieving procedure is done.
You may or may not feel any pain relief in the first few hours after the injection has been administered. This depends on if the nerves that were injected are actually responsible for pain transmission. If the nerves are not the ones transmitting the pain, then you will not feel any pain relief but if they are then you will feel pain relief.
You may be allowed to continue with your regular medications if you are on any medications after the procedure. You are not allowed to take any pain-relieving medication within the first 4 to 6 hours.
This is to allow for the accurate diagnostic result of the cause of pain. You may return to your regular activities the next day.
The major reason for a thoracic medial branch nerve block is to diagnose the exact cause of the pain, hence you may start to feel pain again after the anesthetic has worn out.
Potential risks or complications that may occur from the procedure
Just like every other medical procedure, there are some potential risks or complications that may occur. The risks for this procedure is however very low and complications are very minimal.
The potential risks or complications that may occur in thoracic medial branch block include;
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Bleeding
Bleeding is very rare and only occurs in patients with bleeding disorders.
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Allergic reactions
Allergic reactions occur in patients that are allergic to any of the medication or anesthetic being used.
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Infections
There are cases of minor infections which occur in less than 1% to 2% of patients. Severe cases of infections are very rare.
- Feeling of discomfort at the injection site.
- Some patients may experience worsening of the pain symptoms.
- Rare cases of spinal cord damage or paralysis.