Medial Branch Block

Facet Joint Syndrome

Facet joint syndrome involves a pain that affects a joint found between the spine’s vertebrae. These joints allow bending, twisting and flexibility. You may experience the following symptoms:

  • lumbar and cervical facet joint pain,
  • lower back pain, along with discomfort,
  • inflammation and tenderness around the affected area

What Is Medial Branch Block ?

The medial branch nerve block is the procedure of injecting a local anesthetic on the medial branch nerves that connect to a specific facet joint. The zygapophysial joints, or more commonly known as facet joints, are a section of the skeletal structure in the spinal column. The facet joints are blunt projections from the vertebra, joining with analogous bony studs from the above and below vertebrae. Occasionally, due to severe and persistent conditions, the facet joints can become inflamed. In cases involving the lumbar or lower back facet joints, the pain normally radiates from the lower back, across, and slightly downward, behind the rump and upper thighs. In cases involving the cervical facet joints, the direction of the pain comes from the neck with slight radiation traversing the shoulders, and a more painful symptom as the neck or head is turned from side to side.

What does the procedure look like?

The patient lies on their stomach while being prepared for the procedure.  A medication is administered to relax your nerve while the skin and tissue of the back is desensitized using a local anesthetic. This also desensitizes the skin and tissue around the facet joint suspected to be the source of the patient’s pain.

After the tissue has been desensitized, the physician inserts a needle into the skin, and then into the facet joint. Utilizing a contrast solution, the physician marks the area with the use of an x-ray camera called a fluoroscope. The fluoroscope generates real-time x-ray images, so the physician is able to track the position of the needle.

Once the physician has validated the needle tip’s position, they then install a syringe containing the anesthetics to the needle. The medication is then administered around the medial branch nerves. The anesthetic blocks the pain signals from the facet joints from communicating to the brain.

Once the injection of the anesthetic is determined in being successful in alleviating the patient’s pain, the physician determines whether to use a stronger and a longer lasting anesthetic. Should the procedure fail to alleviate the pain, the physician may decide to test the nearby facet joints to determine the correct one.

Request An Appointment

We want to assure our patients that Portland Pain and Spine remains open and actively managing your pain. Medication management is given the highest priority. Our relocation across the hall in the Washington building is complete but requires office renovation before we can accommodate patient visits. Staffing shortages affected our ability to communicate last month, however, this was temporary. Dr. Balog has reached out to all patients but asks that if anyone has additional questions or concerns to contact him at [email protected].
We have updated our phone messaging system to assist with calls. There are now options to speak with a live receptionist, leave messages or speak with our new billing company. Medical record requests can be processed on our website at and are handled by Morgan Records Management. Thank you for your patience during this transition. We look forward to providing you high-quality care as we enter into 2024! 

Wishing you all a joyful holiday season.