Facet Injection, Medial Branch Block (Lumbar, Thoracic, Cervical)

Medial branch blocks are performed as part of a diagnostic approach to chronic back pain. Medial branch nerves are very small nerve branches that carry pain messages from facet joints to the brain where they are experienced. The facet joints are small joints in the back of the spine that form connections between each vertebra. If these nerves are blocked or numbed, they will not be able to transfer the painful sensation from the joints to the brain. If a patient experiences pain relief when an anesthetic is injected into the nerves of the facet joint, the joint can be confirmed to be the source of the pain.

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1144 North 28th Street
Billings, MT 59101
(406) 237-5900

When Procedure is Used

The cause of back pain is often difficult to diagnose, and facet injections, or medial branch blocks, are one way to identify why back pain is occurring in order to treat it. The procedure will likely be conducted after a patient has tried other ways to achieve pain relief such as anti-inflammatory medications and physical therapy.

During Procedure

You will likely not need any anesthesia for a medial branch block, but you may be given something to help you relax. Using fluoroscopy, or guided x-ray, your surgeon will place a small needle into the facet joint and deliver a small amount of numbing medicine around the nerve. After you have been given the injection, the doctor will assess your pain level. If it has significantly decreased, you will know that the nerves in your facet joint are contributing to your pain, which may indicate that you are a good candidate for a rhizotomy, which is a more permanent way to diminish or eliminate back pain. If you benefit from the procedure, the next step would be consideration for radiofrequency treatment of the medial branch nerves. This a procedure that will provide pain relief for a longer period of time.

The effect will last several hours or more. Since this is strictly a diagnostic block to test the source of pain, it is very important for patients to fill out their pain log that they receive following their procedure. Once the aesthetic wears off the pain will likely return and a patient may have some increased soreness for a day or two.


It has become a standard for the insurance coverage that you need to have two medial branch block injections with a certain level of improvement post injection. Only one level will be done at the time with a minimum of 7-10 days between levels.


The risk of complications is very low, however, potential risks might include:

  • bleeding
  • infection
  • allergic reaction to medication


  • minimally invasive diagnostics

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