Pain Management
Medial Branch Nerve Blocks
Diagnostic and Therapeutic Relief for Facet Joint Pain
The medial branch nerves are tiny nerves that carry pain signals from the facet joints of the spine. When these joints become arthritic or inflamed, they can cause chronic neck or back pain. A medial branch nerve block (MBB) temporarily numbs these nerves, helping confirm whether facet joints are the true pain source. At Desert Spine and Pain, neurosurgeon Dr. David L. Greenwald, M.D., FAANS, FACS uses medial branch blocks as both a diagnostic tool and a short-term pain relief option, often as a precursor to radiofrequency ablation (RFA) for longer-lasting results.
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What Is a Medial Branch Nerve Block?
It’s an injection that numbs the tiny nerves carrying pain from the facet joints. MBB involves percutaneous placement of a spinal needle adjacent to the medial branch nerves under fluoroscopic guidance, followed by injection of local anesthetic ± corticosteroid to block nociceptive transmission.
Conditions Treated
Facet joint arthritis (cervical, thoracic, lumbar)
Chronic neck pain or low back pain suspected to originate from facet joints
Pain that worsens with extension, twisting, or prolonged standing
Diagnostic evaluation before Radiofrequency Ablation
The Medial Branch Block Procedure: Step by Step
Plain-English Overview
Preparation: Outpatient procedure with local anesthesia, mild sedation if needed.
Needle placement: Guided by X-ray into the target nerve location.
Anesthetic injection: Small dose of numbing medicine delivered to medial branch nerves.
Observation: If pain is relieved, facet joints are confirmed as the pain source.
Surgeon-Level Detail
Positioning: Patient prone; sterile prep and draping.
Needle placement: 22–25G spinal needle advanced under AP/oblique/lateral fluoroscopy to the junction of transverse process and superior articular process.
Confirmation: Contrast dye ensures correct placement, avoiding vascular spread.
Injection: Small volume of anesthetic ± steroid injected.
Assessment: Patient’s pain response monitored to confirm diagnostic value.
Benefits of Medial Branch Blocks
Identifies facet joints as pain source
Provides immediate, temporary pain relief
Outpatient procedure with minimal downtime
Guides decision for RFA, which may provide longer relief
Risks & Limitations
Temporary soreness at injection site
Infection, bleeding, or nerve irritation (rare)
Relief is temporary—hours to days—since diagnostic purpose is primary
False positives possible; repeat blocks sometimes needed for confirmation
Recovery Timeline
Day 0: Resume light activity same day; mild soreness possible
Days 1–2: Relief (if facet joints are pain source) confirms diagnosis
Weeks 1–2: Next steps discussed, often leading to RFA if successful
Why Choose Desert Spine and Pain?
Neurosurgical expertise: Dr. Greenwald ensures precision placement under live imaging
Diagnostic clarity: MBBs help pinpoint pain source before committing to longer-term procedures
Comprehensive care: If MBB confirms facet pain, RFA can provide 6–18 months of relief
Patient-centered focus: We explain results clearly and plan next steps with you
Frequently Asked Questions
How long does pain relief from a medial branch block last?
Typically just a few hours to a day. Its purpose is diagnosis rather than long-term therapy.
Why do I need two medial branch blocks?
Some insurers require two positive blocks to confirm facet joint pain before approving RFA.
How is this different from a facet joint injection?
Facet injections put medication directly into the joint. MBBs numb the small nerves outside the joint that transmit pain.
What happens if my block works?
If your pain improves after the block, we’ll likely recommend radiofrequency ablation for longer-term relief.
How does Desert Spine and Pain perform this differently?
We use fluoroscopy-guided, neurosurgical precision, ensuring accurate blocks and reliable diagnostic results.
Dr. David L. Greenwald, MD
Neuro-Spine Surgeon
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If you’re experiencing persistent spinal pain that may be related to arthritis or facet joint issues, a medial branch nerve block could help pinpoint the source and provide meaningful relief. Dr. Greenwald and his experienced team will carefully evaluate your symptoms, review your imaging, and determine if this diagnostic and therapeutic procedure is right for you. Every step you take toward targeted pain management brings you closer to comfort, mobility, and improved quality of life. Schedule your consultation today and discover how Dr. Greenwald’s precision-guided care can help you move with ease again.
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Over 30 Years Experience in Orthopedic & Neuro Spine Surgeries.
Dr. David L. Greenwald, M.D., F.A.C.S.
Neurosurgeon | Spine Surgeon | Regenerative Medicine
Dr. David L. Greenwald, MD, FACS, is a board-certified spine surgeon specializing in medial branch nerve blocks, a targeted, minimally invasive procedure used to diagnose and relieve pain originating from the facet joints of the spine. These joints, located along the back of the vertebrae, can become inflamed due to arthritis or degeneration, causing chronic neck or back pain. During the procedure, Dr. Greenwald uses image-guided precision to inject a small amount of anesthetic near the medial branch nerves that transmit pain signals from the facet joints. If significant relief is achieved, the procedure can also help determine whether a patient is a good candidate for radiofrequency ablation (RFA) for longer-term relief. Dr. Greenwald’s expertise and patient-focused approach ensure safe, accurate, and effective care for individuals throughout South Florida.
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