Consider a medial branch block The injections can also give temporary relief if the issue is indeed nerve-related. If a branch block does not work, there is another issue causing back pain. Doctors can try further tests for a proper diagnosis. Speak with a doctor about the possibility of a medial branch block today.

Patients who undergo medial branch block procedures generally experience dramatic pain relief that may last for up to two years. The block procedure is also used as a diagnostic tool to confirm the location of affected facet joints.

The medial branch block procedure is quick and nearly painless. While lying on the stomach, doctors will administer injections in the back. Doctors will monitor a patient’s vital signs, including blood pressure and oxygen. After the injection site is cleaned, a doctor will inject the medial branch nerves.

A small needle is then guided using an X-ray to the targeted medial branch nerve which is then numbed. I will inject a small amount of X-ray contrast to ensure correct needle placement and a local anesthetic, like lidocaine, to numb to nerve. The injection takes about 15 minutes to complete.

The steroid, when used, takes two to three days to have on effect in most people, and it peaks in about two weeks. Some local tenderness may be experienced for a couple of days after the injection.

The procedure is primarily diagnostic, meaning that if the patient has the appropriate duration of pain relief after the medial branch nerve block, then he or she may be a candidate for a subsequent procedure – called a medial branch radiofrequency neurotomy (or ablation) – for longer term pain relief.

It is recommended that you keep a pain diary for several hours to determine if the procedure worked and for how long. It is OK to travel the day of the medial branch block including plane travel (however avoid driving for at least six hours after the medial branch block).

If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief. On the day after the procedure, patients may return to their regular activities.

How Often Should this Procedure be Done? Medial branch blocks in one area are generally limited to three within a six-month time frame. In many instances, only one or two injections are required to obtain benefit.

Question: Lumbar medial branch blocks were performed on the right at L3, L4, and L5. Would codes 64490, 64491, and 64492 be reported because three different levels were injected? Answer: No. The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints.

Answer: No. The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints.

To block the medial branch nerves that innervate the L4-L5 facet joint, you would target the junction of the TP and SAP at L4 and again at L5. Note this common pattern extends to multiple levels.

The source/path/naming/innervation of the medial branch nerves and their target injection sites can be confusing so keep a few things in mind: Each facet joint is innervated by 2 medial branch nerves. In the lumbar spine, a joint is innervated by a branch from its top level and from the level above it.