Medial Branch Neurotomy
Treating Your Pain
 Back or neck pain may be due to problems with certain nerves that exist at the spine. If so, a medial branch neurotomy can help relieve your pain. The treatment uses heat, cold or chemicals to destroy the nerves near a problem joint. This keeps some pain messages from traveling to the brain and helps relieve your symptoms.
Pain messages may travel along medial branch nerves from problem joints to your brain.
Getting Ready To get ready for your treatment, do the following:
- At least a week before treatment, tell your doctor what medication you take (including aspirin). Ask whether you should stop taking any of them before treatment.
- Tell your doctor if you are pregnant or allergic to any medications
- Stop eating or drinking 8 hours before you check in for your injection, or as directed.
- If asked, bring x-rays, MRI’s, or other tests with you on the day of your treatment.
- Arrange for a driver as you will receive intravenous sedation.
Your Treatment Experience
The treatment is performed in a certified hospital or surgery center. You’ll be asked to fill out forms, including a consent. You may be given an IV (intravenous) line for fluids and medications.
During the Procedure
To help you relax, medication may be given through the IV line. You will lie on an exam table on your stomach, back or side during the procedure.
During your treatment:
- The skin over the treatment site is sterilized and anesthetized with local anesthesia medication.
- Fluoroscopy (x-ray imaging) is used to help your doctor see the spine and guide the treatment. A contrast “dye” may be injected into the affected region to help get a better image.
- Heat, cold, or chemicals are used to destroy part of the nerve near the inflamed facet joint. Other nerves nearby may be also treated.
Fluoroscopy is used to help guide the treatment.
After the Procedure
Most patients will be able to go home one hour after their procedure. Have an adult drive you home. The treated area may be swollen or may feel more irritated than usual. This is normal and may last for a day or so. It will be a few days before you feel relief from your symptoms. Your doctor may prescribe pain medication for you during that time. Ask him or her when it’s OK for you to go back to work. Ice application in the first 24 hours (20 minutes\ 40 minutes off) is an option to relieve this discomfort.
Relax at home for the rest of the day after your treatment.
When to Call Your Doctor
Call your doctor if you have a fever over 101 Degrees Fahrenheit, chills or redness or drainage at the treatment site.
Risks and Complications
Risks and complications are rare but may include:
- Infection
- Increased pain, numbness or weakness
- Nerve damage
- Bleeding
- Failure to relieve pain
Each vertebra in your spine has facets (flat surfaces). They interpose where the vertebrae fit together. This forms a facet joint. Each facet joint has at least two medial branch nerves. They are part of the nerve pathway to and from each facet joint. A facet joint in your back or neck can become inflamed (swollen and irritated). Pain messages may then travel along the nerve pathway from the facet joint to your brain.
Blocking Pain Messages
Medial branch nerves in each facet joint send and carry messages about back or neck pain. Destroying a few of these nerve fibers can keep certain pain messages from reaching the brain. This can help bring you relief.
Discussing Your Results
Relief from pain can help you enjoy your life again. Let your pain doctor know if you still have pain after your treatment. The treated nerves will often regrow within 6 months to a year. At that time, you may need repeat treatment.
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