Medial Branch Block

MEDIAL BRANCH BLOCKWhat is a Medial Branch Block?

A medial branch block (MBB) is an integrative approach to treating back and spinal pain that arises as a result of a painful facet or spinal joint.

Also known as a facet block, this diagnostic procedure uses a local anesthetic injection to numb the nerve that innervates the joints, identifying which particular joints in the spine are causing pain.

Pain relief after the procedure indicates that the correct nerve and subsequent joint has been identified during the medial branch block as the cause of a patient's back or spine pain.

Common Symptoms We See in Our Patients

Common symptoms of facet joint inflammation and irritation include at least three months or more of moderate to severe pain:

  • in the upper back or neck region—this pain radiates from the spine up to your neck, shoulders, and head
  • while bending back or twisting your torso
  • radiating down to the buttocks, hip, and even back of the thigh

Patients suspected of having facet joint pain do not experience relief from the use of NSAIDs, physical therapy, or acetaminophen. The source of the pain cannot be explained by injuries such as a neck or spinal fracture, tumor, or infection.

What is Causing My Back and Neck Pain

Back and neck pain is typically multifaceted in nature. However, it can arise due to inflammation and irritation due to arthritis or injury to the facet joints. These small joints are present in the back of your spine, between the vertebrae, and support the movement of one's back by allowing flexing, bending, and twisting of the spine.

A medial block branch serves mainly as a diagnostic procedure used to identify both the area and cause of the patient's back pain. While the pain relief experienced after the procedure may be temporary, it is an essential step for patients before they undergo other procedures such as radiofrequency ablations for longer-term relief of pain.

How Will You Treat My Neck or Spinal Pain

A medial branch block is a quick outpatient procedure that typically takes 15 minutes. Used to diagnose and identify facet joint pain, an MBB is performed by an MMB Specialist or certified healthcare professional such as a board-certified anesthesiologist or pain medicine specialist.

It's common for an MBB to be done twice, several days apart, with the first injection using a long-acting local anesthetic. The second procedure uses a shorter-acting anesthetic.

During the MBB, you will be placed in the prone position on an X-ray table with your back scrubbed clean with an antiseptic cleanser. Then, using X-ray guidance, the doctor directs the injection to the suspected area of pain.

A local anesthetic numbs the skin area before needles are injected next to the medial branch nerves to block them from sending pain impulses to the joint. Following this, the doctor will inject a contrast dye to ensure that the medication is injected into the right place. The numbing medicine is finally injected into the areas before you are taken to the outpatient recovery area.

What to Expect After an MBB?

After the procedure, we discharge our patients to their designated driver and ask that they be active and attempt to trigger their usual back or neck pain. Depending on the severity of your symptoms of neck or spinal pain, you may be asked to track your post-procedure pain symptoms in a pain diary in order for us to determine the effectiveness of your diagnostic procedure.

While the risks of an MBB are rare, they may include:

  • nerve damage
  • bleeding and bruising at the injection site
  • infection
  • worsening of pain
  • elevated blood sugar levels in patients with diabetes
  • weakness or numbness in nearby nerves due to local anesthetic for up to several hours post-procedure
  • fluid retention

Most patients after an MBB procedure report feeling immediate pain relief. Your doctor will discuss further treatment options, such as a radiofrequency facet ablation (RFA) for longer-term pain relief.


If you are dealing with severe spinal or neck pain and want to learn more about integrated approaches to improve your condition, call Scott Wagner Integrated Medicine in Charlottesville, VA, at (434) 978-4888 to learn more.


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