7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Medial Branch Blocks/Rhizotomy

 

What it is used to treat?

 

Medial branch blocks are used to block pain coming from a the small joints in the back part of the spinal column- either in the low back, thoracic spine or neck.  Inflammation or arthritis in these joints can lead to severe pain usually restricted to the area near the joint, but sometimes radiating to the buttocks or upper legs or the shoulders and arms or chest wall.

 

What the goal/purpose?

 

The goal is to stop the small nerves innervating the facet joints from sending pain signals to the brain.  The point of this is first to relief pain and second to allow you to rehab and strengthen your core and back, so hopefully the pain will not return to as great a degree.

 

What should I do to get ready for the procedure?

 

Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol.   Read the list of medications that must be stopped that was given to you at your office visit. (link) Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke.  It is your responsibility to clear this with your doctor.

 

Continue to take your other medications.  Do not stop blood pressure or diabetes medicines.

 

Do not eat or drink anything on the morning of your procedure.  You may eat and drink afterward.

 

If you wake up with no pain the day of the procedure call us before coming in.

 

How is it done?

 

Patients lie face down on the procedure table.  Monitors are attached to keep track of your vital signs during the procedure.  The area over the procedure site is prepped and draped in a sterile manner to protect against infection.  A fluoroscopic x-ray is then used to locate the target site.  The skin is numbed with lidocaine and a needle is advanced toward the target under x-ray guidance.

 

The procedure requires a three step process- two separate diagnostic test followed by the radiofrequency ablation/rhizotomy, if both test are positive.

 

The initial step in this procedure is to perform a test nerve block where we inject lidocaine next to the nerve to test whether or not this relieves your pain.  This test will only relieve the pain temporarily.  We want to see at least 80% reduction in pain for the test to be considered a success.

 

If the first test is successful, insurance rules require a second confirmatory test two weeks later.

 

If both test are successful, we can proceed to the rhizotomy or heating of the nerves to give longer lasting relief.  If either of the diagnostic test fail to give relief, we will not proceed to heating the nerves.

 

It is very important on the days of the test that you have pain when we do the test.  If you happen to wake up with no pain on test day, simply call and reschedule.

 

These injections are performed using x-ray guidance and usually include 3-5 little injections on each side of the spine.

 

After the test, you must stay awake for several hours to see if you received relief from the test.  We suggest going out to breakfast after the test and then doing activities that would normally not be possible.  Please call us 4-6 hours after the test and report your results

 

What is injected?

 

For the diagnostic tests Lidocaine and Ropivacaine are used- one or the other at each test.

During the rhizotomy, lidocaine and a steroid are injected near the nerve, and lidocaine is used to numb the skin

 

Will it hurt?

 

Most people tolerate these procedures very well.  There is some discomfort associated with numbing the skin, and there may be pressure during the injection.  Some patients require some sedation for the procedure, and others do not. The vast majority of patients tell us ‘that wasn’t so bad” or “I can’t believe I was worried about that;” however some people do find it painful and may require sedation.

Important Warning!

 

After a rhizotomy some patients develop increased pain due to the heat applied to the nerves- this can last up to 6 weeks.  If you are having a flare up call us.  Patients taking gabapentin/Neurontin or Lyrica are less likely to have a flare up.  Sometimes the flare up will require oral steroids or even an injection to calm it down

 

What is the chance of success?

 

Approximately 75% of our patients get significant relief from this type of procedure.

 

How often can the procedure be repeated?

 

We start with the diagnostic or test blocks which are spaced two weeks apart. If both give at least 80% relief, we proceed to the radio frequency thermal coagulation or rhizotomy. The rhizotomy may take up to 6-8 weeks to show maximum improvement, and the improvement will usually last 4 months to a year or longer. As long as you get meaningful relief that lasts for a reasonable period of time (6 months minimum), this procedure can be repeated up to two times per year.

 

What can I do to maximize my chance of success?

 

Be consistent in your home stretching exercises and core strengthening program.  Work to get close to your ideal body weight.  Be careful not to reinjure your spine.  Remember that even though you are feeling better, you have to protect your gains and be conscious of how you move.

 

Why do I have a blue towel in my pants?

 

We place a sterile towel over the injections sites to absorb any mild bleeding and protect your cloths.

 

Why are there EKG pads still in place?

 

If you have thin skin or hair in the area, we may leave the EKG pads in place so that you can gently remove them with soap and water at home.

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