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Medial Branch Denervation

What is Radiofrequency Medial Branch Denervation?

The facet joints in the back are a common source of pain.  Medial branch denervation is a procedure that in some carefully selected patients can give useful relief of their pain for a prolonged period.

The facet joints are supplied by small nerves which come off the main nerve roots emerging from the sides of the spine.  These are called the medial branch nerves.  They run towards the facet joints around the back of the vertebra.  

medial branch

A special needle is inserted under local anaesthetic and x-ray guidance until it sits alongside the median branch nerve.  A gentle electrical current is passed through the needle tip and, if the needle is close to the nerve, this will result in a sensation, often of warmth or buzzing.  Then, after injection of a small dose of local anaesthetic, the tip of the needle is gently heated using radiofrequency electrical impulses to very precisely damage the nerve to stop the pain signals.  The electrical stimulation and x-ray guidance allow very accurate positioning of the needle on the correct nerve. 

Occasionally pulsed radiofrequency to the medial branch nerves can be used as an alternative to full radiofrequency lesioning.

 

 Are there any side effects?

As with any injection, there may be some bruising or a flare-up of pain for a short period afterwards.   With accurate positioning and stimulation testing the risk of damage to other nerves is extremely low.

The medial branch nerves also supply small muscles in the back called the multifidus, and so medial branch denervation can also cause some weakness of these muscles.  For this reason we would try to limit the use of the technique to the smallest possible number of nerves, and only do the procedure when prior diagnostic nerve blocks had given a clear indication of likely benefit. 

 Our patient information sheet about Medial Branch Denervation can be accessed here.

 

 

 

 

 

 

 

 

 

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 19/02/2016