Medial Branch Block (MBB) & Radiofrequency Ablation (RFA)

MBB and RFA are minimally invasive procedures designed to diagnose and treat facet joint pain in the spine. MBB helps identify pain sources, while RFA provides longer-term relief by targeting specific nerves.

What are MBB and RFA?

  • Medial Branch Block (MBB): A diagnostic injection to confirm facet joint pain.

  • Radiofrequency Ablation (RFA): A treatment that uses heat to disrupt nerve signals, reducing pain.

Common conditions treated

  • Facet joint pain caused by arthritis or injury.

  • Chronic back or neck pain originating in the spine.

Benefits

  • MBB: Identifies pain sources for targeted treatment.

  • RFA: Provides long-term pain relief without surgery.

Preparation & Post-Care

  • Before: Stop blood thinners and fast for 3 hours before the procedure. Conscious sedation is used in RFAs. Undergoing sedation requires a driver.

  • After MBB: Complete a pain log to assess relief.

  • After RFA: Expect soreness for 1-2 weeks, with maximum relief expected in 3-4 weeks.

  • MBB (Diagnostic Test):

    1. Preparation: The skin is numbed with a local anesthetic.

    2. Needle Guidance: X-ray guidance ensures accurate needle placement.

    3. Anesthetic Injection: Pain relief helps determine the facet joints as the source of pain.

    RFA (Therapeutic Procedure):

    1. Preparation: The skin is numbed, and IV access is placed for conscious sedation.

    2. Sedation: Conscious sedation helps you relax while remaining responsive.

    3. Needle Guidance: Using X-ray guidance, a needle is directed near the target nerve.

    4. Nerve Cauterization: Heat is applied to disrupt nerve signals, reducing pain.

  • MBB provides temporary relief to confirm diagnosis. RFA relief can last 6-12 months or longer.

  • Discontinue the following medications:

    • Lovenox (enoxaparin) 12-24 hours prior to procedure

    • Integrilin (eptifibatide) 1 day prior to procedure

    • Aggrastat (tirofiban) 1 day prior to procedure

    • Pletal (cilostazol) 2 days prior to procedure

    • Trental (pentoxifylline) 2 days prior to procedure

    • Eliquis (apixaban) 3 days prior to procedure

    • Savaysa (edoxaban) 3 days prior to procedure

    • Xarelto (rivaroxaban) 3 days prior to procedure

    • Pradaxa (dabigatran) 3 days prior to procedure

    • Arixtra (fondaparinux) 4 days prior to procedure

    • Aspirin 5 days prior to procedure

    • Warfarin (coumadin) 5 days prior to procedure

    • Reopro (abciximab) 5 days prior to procedure

    • Brilinta (ticagrelor) 5 days prior to procedure

    • Aggrenox (dipyridamole) 7 days prior to procedure

    • Plavix (clopidogrel) 7 days prior to procedure

    • Effient (prasugrel) 7 days prior to procedure

    • Ticlid (ticlopidine) 14 days prior to procedure

  • What should I do before the procedure?

    • Medication: Stop blood thinners and specific medications as directed by your provider.

    • Fasting: Avoid eating for 3 hours before the procedure; clear liquids are allowed up to 1 hour before.

    • Allergies: Inform your doctor if you’re allergic to latex, adhesives, anesthetics, steroids, or contrast dye.

    • Arrange Transport: If sedation is used, plan for someone to drive you home.

  • Avoid submerging the injection site in water for 24 hours and limit vigorous activities.

This video explains the steps of a RFA, showing how it provides relief.