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Damian asked...

Broad-based central and right paracentral disc bulge...

Hello, I have recently been diagnosed that at my spine L5-S1 there is a broad-based central and right paracentral disc bulge which contains focus of high T2 signal consistent with small annular tear. The leading doctor offered me bilateral lumbar medical branch blocks. Can you please tell me for how long it will take the pain away and how it can impact my future life? I just finished 30.

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The answer

Thank you for your question and we're sorry to hear about your back pain.

An annular tear is a rupture of the outer layer of the discs that sits between vertebrae. When this happens the liquid inside the disc will leak out and might cause irritation of nearby nerves, hence causing pain and/or weakness. This usually happens with the ageing process but, considering your young age, can be related to a trauma or a sports injury.

The proposed treatment by your doctor, medial lumbar branch block, will have two purposes, diagnostic and short term pain relief. Should the pain improve, your doctor might then proceed to offer a second procedure which will have a long term effect on pain management, called Medial Branch Radiofrequency Neurotomy or Ablation.

In regards to the pain, you should feel immediate relief of the pain after the injection, provided that the affected nerves are the ones being treated. This will go away after approximately 4 to 8 hours.

Of note that by National Institute for Health and Care Excellence (NICE) guidance, medial branch block and ablation are not recommended as a standard procedure. These should only occur in patients where non-invasive therapy has not worked and back pain has been long standing.

Should the pain resolve the impact on your daily life should be minimal, although some adjustments might be needed. If you play any contact sports or strain your back frequently you might need to look into adapting your work flow to protect the affected area. As this is mainly a diagnostic procedure you won’t see many changes to your lifestyle until something more permanent is done.

Nice guidelines for back pain

Medial Branch Block Duration

Answered by the Health at Hand nurses