Epidural Steroid Injection vs Medial Branch Block
Auto injuries can cause many symptoms within the body depending on the mechanism of injury. Common symptoms include neck, mid back and lower back pain with or without radiating symptoms down the arms and legs. An initial exam is highly recommended after an auto accident to assess each part of the body and prevent permanent damage to the spine and nerves. Early intervention such as Epidural Steroid Injections or Medial Branch Blocks can prevent pain from becoming chronic, which could lead to more invasive surgeries and procedures being necessary in the future. At Complete Care Spine & Orthopedics in Central Florida, our orthopedic specialists perform thorough examinations and state of the art diagnostic testing to get a clear picture of a patient’s injuries and how they can help reduce their symptoms in the least invasive ways possible.
If cervical, thoracic, or lumbar pain does not fully resolve after a patient goes through conservative care, there are many minimally invasive options that can provide long term pain relief. Two common procedures recommended by orthopedic specialists are Epidural Steroid Injections and Medial Branch Blocks. While both procedures are highly effective in reducing pain, they are not used interchangeably. They each have a precise way of targeting pain and are prescribed based on the patient’s specific injury and test results.
What is an Epidural Steroid Injection (ESI)?
An epidural steroid injection delivers steroid medication directly into the epidural space in the spine.
What is the Benefit of an ESI?
Steroid medications are powerful anti-inflammatory agents, which help reduce inflammation around the spinal nerves which may be irritated due to a herniated or bulging disc. The saline mixed into the injection works by “flushing” or diluting the body’s automatic inflammatory fluids, also reducing pain.
What is a Facet Block or Medial Branch Block (MBB)?
A facet block or medial branch block involves injecting a small amount of local anesthetic (numbing agent) into the facet joint or surrounding the medial branch sensory nerve, depending on the specific approach. By placing the numbing agent specifically around either the facet joint or the medial branch nerve, the level of immediate pain relief experienced will confirm that the area injected is the source of pain. In other words, it is a diagnostic test. This procedure is not meant for long-term relief but can benefit some patients for longer than the expected 1-3 hours.
What is the Benefit of an MBB?
The presence of pain relief is an indicator that the next step of the procedure can be performed. The patient would then return to the office for Step 2, a Radiofrequency Neurotomy (RFN). This is the second step for long lasting pain relief. Radiofrequency neurotomy is a type of procedure used to treat joint/nerve pain. In this technique, radiofrequency energy is used to burn, or cauterize, the sensory nerve. This approach interrupts the sensory nerve’s pain signal to the brain; it does not affect the major spinal nerves responsible for strength and sensation. The RFN will often provide long-term pain relief lasting an average of 9 to 14 months, and sometimes even longer since the nerve may regenerate, and the pain may or may not return.
How Does a Provider Determine Which Procedure is the Best Option for a Patient?
When a patient comes to Complete Care Spine & Orthopedics, they typically have already had diagnostic imaging performed such as X-Ray and MRI. These studies show the status of the intervertebral discs, the amount of space available for the nerves that come out of the spinal column, as well as the degree of inflammation that is in the area. A thorough health history and orthopedic examination reveal the severity of the pain, if radiating symptoms are present, and where the source of pain is coming from. From there, the doctor may order additional testing. Once all necessary information is gathered, our orthopedic specialist can formulate a diagnosis and plan of action. The decision between performing an ESI or MBB depends on a few key factors.
ESI’s are typically prescribed for patients with severe inflammation around the intervertebral disc caused by either a disc bulge or herniation. This inflammation puts pressure on the nerve, causing local and radiating symptoms such as pain, numbness or tingling in the arms or legs. The steroid can effectively reduce this inflammation, thus minimizing the pressure on the nerve and relieving the symptoms.
MBB’s on the other hand are indicated by facet (joint) pain that is commonly localized to a certain area of the spine. The medial branch of a nerve is the “pain producing” part of the nerve. By numbing this nerve, it is an effective way of determining that it is truly the source of pain before the RFN is performed. MBB’s do not involve the use of steroids but rather a numbing agent such as Lidocaine.
Modern technology has highly benefited thousands of patients by providing pain relief without the need for spinal surgery. At Complete Care Spine & Orthopedics we are proud of our orthopedic team and their abilities to test, diagnose and treat patients suffering from auto injuries. We provide not only interventional pain management, but also orthopedic spine and extremity surgery and neurology. For more information on how we can help, contact our team today. We provide convenient appointments at our three locations in Central Florida, transportation, translation services and timely medical records and billing.