Cervical Medial Branch Block

A cervical medial branch block is a minimally invasive injection that delivers numbing medicine (local anesthetic) ± a small amount of steroid directly to the tiny medial branch nerves that supply sensation to the facet joints in your neck. These nerves can become irritated and cause chronic neck pain, headaches, or pain that radiates into the shoulders and upper back.

It serves two main purposes:

1. Diagnostic: To confirm whether your facet joints are the true source of your pain. If the pain goes away (even temporarily) after the block, we know the facet joints are the pain generator.
2. Therapeutic: To provide pain relief (usually weeks to months when steroid is added).

How long does pain relief last?

• Diagnostic block (anesthetic only): 4–18 hours of relief
• Therapeutic block (anesthetic + steroid): several weeks to 6–12 months in many patients Results vary widely from person to person.

How are the Procedures done?

• You lie face-down on an X-ray table.
• The skin is cleaned and numbed with local anesthetic.
• Using live X-ray (fluoroscopy) guidance, the doctor places thin needles next to the target medial branch nerves (usually 4–8 nerves total, 2–4 levels).
• A small amount of contrast dye is injected to confirm perfect needle position.
• The medication is then injected. Total procedure time: 10–20 minutes.

Is the procedure painful?

Most patients feel pressure or a brief burning sensation when the local anesthetic is injected into the skin, but the procedure itself is generally well-tolerated. We can provide mild sedation (oral or IV) if you are very anxious.

Do I need a driver?

Yes. Sedation is commonly used, and if used an adult is required to take you home.  Also with sedation you are to fast for 8 hours prior to the appointment.

When can i go back to work or drive?

• Same day if no sedation was used.
• Next day if you received IV sedation.
• Avoid strenuous activity or heavy lifting for 24 hours.

How long is the recovery time?

You rest for 10–30 minutes after the procedure. Most people resume normal activities the next day, but we recommend avoiding strenuous activity for 24–48 hours.

What should i expect after the injection?

• Mild soreness at the injection site for 1–2 days (ice and over-the-counter pain medication usually help)
• Temporary numbness or weakness in the arms (usually resolves within hours)
• Possible flushing, slight weight gain, or mood changes from the steroid (usually mild and temporary)
• Gradual improvement in your usual neck/arm pain over the next 1–7 days

What are the risks and side effects?

Common (usually temporary):

• Temporary pain at injection site
• Headache (1–2%)
• Flushing, sweating, or warmth
• Temporary numbness or weakness in legs
• Sleeplessness or anxiety for 1–2 days
• Slight increase in blood sugar (important for diabetics)

Rare but serious (<1%):

• Infection
• Bleeding
• Nerve injury
• Dural puncture (spinal headache)
• Allergic reaction to medication
• Very rare: paralysis or death

Are there any contraindications?

Yes. The procedure is typically not performed if you have:

• Active infection or fever
• Bleeding disorder or taking blood thinners (some can be held)
• Uncontrolled diabetes or congestive heart failure
• Allergy to contrast dye or local anesthetics
• Pregnancy

How should I prepare for the procedure?

• Stop blood thinners (aspirin, Plavix, Coumadin, Eliquis, etc.) only if cleared by your prescribing doctor.
• Inform us if you have diabetes (we may adjust insulin/medications).
• Do not eat or drink for 4–6 hours before if sedation is planned.
• Bring a driver.