Lumbar Medial Branch Blocks

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What is a Lumbar Medial Branch Block (MBB)?

A lumbar medial branch block is a minimally invasive injection that delivers anesthetic (and sometimes a small amount of steroid) to the medial branch nerves. These tiny nerves carry pain signals from the facet joints in your lower back to your brain. The procedure is both diagnostic (to confirm if the facet joints are the source of your pain) and therapeutic (to provide temporary or longer-lasting relief).

Why would my doctor recommend this procedure?

Your doctor may recommend an MBB if:

• You have chronic lower back pain that worsens with twisting, arching, or prolonged standing/sitting
• Imaging (X-ray, MRI) shows facet joint arthritis or degeneration
• Physical therapy, medications, and other conservative treatments have not helped
• Your doctor needs to determine whether the facet joints are the primary pain generator before considering radiofrequency ablation (rhizotomy)

How long does pain relief last?

• Diagnostic block (anesthetic only): 4–18 hours of relief
• Therapeutic block (anesthetic + steroid): several weeks to 6–12 months in many patients Results vary widely from person to person.

How are the Procedures done?

• You lie face-down on an X-ray table.
• The skin is cleaned and numbed with local anesthetic.
• Using live X-ray (fluoroscopy) guidance, the doctor places thin needles next to the target medial branch nerves (usually 4–8 nerves total, 2–4 levels).
• A small amount of contrast dye is injected to confirm perfect needle position.
• The medication is then injected. Total procedure time: 10–20 minutes.

Is the procedure painful?

Most patients feel pressure or a brief burning sensation when the local anesthetic is injected into the skin, but the procedure itself is generally well-tolerated. We can provide mild sedation (oral or IV) if you are very anxious.

How should i prepare for the procedure?

• Stop blood thinners (aspirin, Plavix, Coumadin, Eliquis, etc.) only if cleared by your prescribing doctor.
• Inform us if you have diabetes (we may adjust insulin/medications).
• Do not eat or drink for 4–6 hours before if sedation is planned.
• Bring a driver.

Do I need a driver?

Yes. Sedation is commonly used, and if used an adult is required to take you home.  Also with sedation you are to fast for 8 hours prior to the appointment.

When can i go back to work or drive?

• Same day if no sedation was used.
• Next day if you received IV sedation.
• Avoid strenuous activity or heavy lifting for 24 hours.

How long is the recovery time?

You rest for 10–30 minutes after the procedure. Most people resume normal activities the next day, but we recommend avoiding strenuous activity for 24–48 hours.

What should i expect after the injection?

• Mild soreness at the injection site for 1–2 days (ice and over-the-counter pain medication usually help)
• Temporary numbness or weakness in the arms (usually resolves within hours)
• Possible flushing, slight weight gain, or mood changes from the steroid (usually mild and temporary)
• Gradual improvement in your usual neck/arm pain over the next 1–7 days

What are the risks and side effects?

Common (usually temporary):

• Temporary pain at injection site
• Headache (1–2%)
• Flushing, sweating, or warmth
• Temporary numbness or weakness in legs
• Sleeplessness or anxiety for 1–2 days
• Slight increase in blood sugar (important for diabetics)

Rare but serious (<1%):

• Infection
• Bleeding
• Nerve injury
• Dural puncture (spinal headache)
• Allergic reaction to medication
• Very rare: paralysis or death

Are there any contraindications?

Yes. The procedure is typically not performed if you have:

• Active infection or fever
• Bleeding disorder or taking blood thinners (some can be held)
• Uncontrolled diabetes or congestive heart failure
• Allergy to contrast dye or local anesthetics
• Pregnancy