The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint - A physiologic challenge

Study Design. Randomized, controlled, single-blinded study. Objectives. To determine the physiologic effectiveness of lumbar medial branch blocks. Summary of Background Data. Zygapophysial joint pain can be diagnosed by anesthetization of the joint or its nerve supply (the medial branch divisions of the dorsal rami). The physiologic effectiveness of lumbar medial branch blocks has been assumed but not proven. Methods. Eighteen asymptomatic individuals were randomly assigned to either L4-L5 or L5-S1 zygapophysial joint injections with contrast medium until capsular distention elicited pain without extracapsular contrast spread. One week later, 15 blinded individuals underwent two randomized saline or 2% lidocaine medial branch injections that correlated to the innervation of the previously injected joint. Medial branch injections were performed such that inadvertent venous uptake was avoided in 14 individuals. Thirty minutes after medial branch injections, these 14 individuals underwent repeal capsular distention of the same zygapophysial joint provoked the prior week in an attempt to elicit another painful response. Results. All five control individuals who received saline medial branch injections felt pain on repeat capsular distention. Nine individuals received 2% lidocaine medial branch blocks; eight fell no pain, and one felt pain on repeat capsular distention. Conclusions. There was a significant effect of 2% lidocaine (versus saline) medial branch injections on anesthetization of the zygapophysial joint when venous uptake was avoided during these injections. When properly performed, lumbar medial branch blocks successfully inhibit pain associated with capsular distention of the lumbar zygapophysial joints at a rate of 89%.