Medial Branch Block

A medial branch nerve block is a procedure of injecting a potent local anesthetic on the medial branch nerves that is connected to a specific facet joint

The zygapoghysial joints or more commonly known as the facet joints is a section of the skeletal structure of the spinal column. The facet joints are tiny blunt projections from one vertebra, joining with like bony studs from the vertebra on top and at the bottom. At times, because of a number of severe, and persistent conditions, the facet joints can get inflamed. For lumbar or lower back facet joints, the pain normally radiates from the lower back and radiates across and slightly down behind the rump and upper thighs. For cervical facet joints, the direction of the pain is from the neck with a slight radiation traversing across the shoulders, with a more painful symptom when the neck or head is turned from side to side.


The patient lies down on their stomach while getting ready for the procedure.  A medication to relax your nerve is given while the skin and tissue of the back is desensitized using a local anesthetic. This also desensitizes the skin and tissue covering  the facet joint that is allegedly the source of the patient's pain.

Contrast Dye Injected

After that the tissue has been desensitized, the doctor slides a needle into the skin which is skillfully inserted down to the facet joint, with the help of a contrast solution, the physician marks the area with the use of an x-ray camera called a fluoroscope. The fluoroscope generates real-time xray images, which the physician uses to validate the location of the needle’s tip.

Anesthetic Injected

After the physician has validated the needle tip’s position, the doctor installs a syringe containing the anesthetics to the needle.  This medication is then administered around the medial branch nerves.  The anesthetic blocks the pain signals from the facet joints going to the brain.

End of Procedure

If the injection of the anesthetic was successful in relieving the patient’s pain, the physician may opt to use a stronger and a longer lasting anesthetic. Should the procedure fails to relieve the pain, the physician may opt to test nearby facet joints to find out the correct one.