Ultrasound-Guided Cervical Medial Branch Block and Facet Joint Injection

Ultrasound-Guided Cervical Medial Branch Block and Facet Joint Injection

Ultrasound-guided medial branch block and facet joint injection are minimally invasive techniques used to diagnose and treat chronic facetogenic neck pain. The cervical facet joints are a common source of neck pain that often refers to the head, the back of the neck and the interscapular region; when it does not respond to conservative treatment, these injections allow the source of pain to be located and treated precisely.

Key Takeaways

• A real-time ultrasound-guided technique, with no ionizing radiation.
• The medial branch block has both diagnostic and therapeutic value.
• The approach is planned based on each patient's imaging findings.
• If relief is significant but temporary, radiofrequency ablation can be considered.
• Indicated in chronic mechanical neck pain, facet arthropathy, cervicogenic headache and post-whiplash pain.

Procedure Video

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What Does the Medial Branch Block Involve?

It involves injecting local anesthetic onto the medial branches, which are responsible for transmitting pain signals from the facet joints. Each facet joint is innervated by the medial branches of the dorsal ramus of the cervical nerves. The technique comprises two complementary approaches:

• Medial branch block: injection of local anesthetic onto the medial branches. It has a diagnostic value —to confirm the facet joint as the pain source— and is also therapeutic.
• Facet joint injection: direct injection of local anesthetic into the joint, combined with corticosteroids in selected cases.

How Is the Treatment Planned? (This Case)

The strategy is planned according to each patient's findings. In this case, MRI demonstrated facet joint synovitis at one cervical level, so a direct facet joint injection was performed at that level.

The remaining injections were targeted to the corresponding medial branches, which carry the pain originating from the cervical facet joints.

When Is It Indicated?

I usually consider this technique in patients with:

• Chronic mechanical neck pain with facetogenic features
• Degenerative facet joint arthropathy
• Cervicogenic headache
• Persistent neck pain after whiplash injury

Why Guide It With Ultrasound?

Ultrasound guidance allows precise identification of the articular pillars and the course of the medial branch, as well as visualization of vascular structures to perform the puncture safely. Its main advantages are:

• Real-time visualization of the needle and anatomical structures
• Vessel identification and greater safety during the puncture
• Greater accuracy in placing the anesthetic
• No ionizing radiation, unlike the fluoroscopy-guided technique

What Happens After the Procedure?

Following the technique, there is a brief observation period and the evolution of pain is tracked over the following hours, which helps confirm the diagnosis:

1. A brief observation period in the clinic
2. Tracking the evolution of pain over the following hours
3. Progressive return to usual activity within a tolerable pain range

What If Relief Is Only Temporary?

Diagnostic and therapeutic medial branch blocks help identify patients who may benefit from radiofrequency ablation of the medial branches: when pain relief is significant but temporary, radiofrequency can achieve longer-lasting relief.

Consult with Dr. Santiago Robles

If you suffer from chronic neck pain and want to know if a medial branch block or facet joint injection may be a treatment option for your case, don't hesitate to schedule a consultation. Dr. Santiago Robles specializes in ultrasound-guided interventional techniques and offers a personalized evaluation for each patient.