DrJED Talks: Nerve Blocks (MBB’s) and Ablations -short

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Dr.

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Jed here. Today we’re talking about a treatment called

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lumbar spine medial branch blocks, which leads to an RFA

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that stands for radial frequency ablation.

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Sometimes it’s called burning the nerves to begin with.

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It is a treatment directed towards a very specific

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pain generator.

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That pain generator is what is called the facet joints.

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This happens to be a lumbar spinal model.

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So I will say a lumbar facet joint.

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However, the same principle applies up in the neck.

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That would be cervical facet joints.

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You could also undergo cervical facet joint medial branch

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blocks, followed by cervical facet joint RFA.

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So what is a medial branch block

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and, uh, is it appropriate for you to begin with

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the RFA, the ablations address pain coming from

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these specific joints?

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Only if your pain is coming from a pinched nerve

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and your pain is down the leg,

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it’s not gonna help that sort of pain.

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If your pain is just across the back, is it made worse

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with prolonged standing even sometimes five, 10 minutes,

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sometimes worse with, uh, first rising from a chair

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and having to stand up.

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So let’s say for example, you’ve undergone physical therapy,

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home exercises

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and anti-inflammatories, that’s ibuprofen, naproxen,

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if you can tolerate them and you still have that pain there.

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If your physician has found that you seem a likely candidate

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for this procedure, it’s a three step process.

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The first step is performing the lumbar spine

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medial branch block.

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And this is done under fluoroscopic guidance.

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That is live action X-ray. You would go to a surgery center.

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Uh, you’d go in the back in there,

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what’s called the fluoroscopy suite.

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They use what’s called a C-arm and they take pictures

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and guide a needle down.

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This would be the L five S one, L four five.

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That would be the L three four.

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So if you go down and you put needles right there,

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right there, right there, and shoot numbing medication,

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and your pain drops by 80%,

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you are gonna be a good candidate for an RFA.

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Now, to make sure that you are the best candidate,

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you do have to repeat that procedure twice.

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Okay? Let’s say for example,

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you do the medial branch blocks the mbbs twice,

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and you get that 80% reduction in pain.

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Then you would come back a few weeks later

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and undergo what is called the RFA.

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That is the radial frequency ablation.

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You use slightly different trajectories on your needles

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because, uh, you wanna lay those needle tips right there.

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Uh, then you do a few different things

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to make sure the needle tips,

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the probes are exactly placed where you want them.

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Then you flip the switch and you burn those nerves.

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And once those nerves are burned,

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sometimes the pain reduction response

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Isn’t immediate. It

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takes a few days to, uh, a week or two to build up,

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but then your, your brain no longer has

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to hear about pain coming from those joints,

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and that pain reduction response can last six months,

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12 months, 18, even up to 24 months.