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Lumbar Medial Branch BlockDiagnostic and therapeutic lumbar medial branch blocks to confirm facet joint pain as the source of chronic low back pain and determine candidacy for radiofrequency ablation — performed under fluoroscopy at Remix Medical in Houston, TX.

Specialty
Pain Management
Type
Procedure
Body location
Lumbar facet joints, L3-L4, L4-L5, L5-S1, lumbar medial branch nerves, dorsal ramus
CPT code
64493 (lumbar/sacral, single level), 64494 (second level, add-on), 64495 (third level and beyond, add-on); 77003 (fluoroscopic guidance, when reported separately)

Also known as: Lumbar MBB, Medial Branch Nerve Block, Facet Nerve Block, Lumbar Facet Block

Lumbar Medial Branch Block in Houston, Texas

About one in five patients with chronic low back pain has facet joint pain. There is no imaging finding that proves it and no physical exam maneuver that confirms it. The only reliable way to identify it is to anesthetize the nerves that carry sensation from those joints and see whether the pain stops.

That is what a lumbar medial branch block does.

What is a Lumbar Medial Branch Block?

Each facet joint in the lumbar spine receives sensory innervation from two small nerves called medial branches. A medial branch block places a tiny volume of local anesthetic onto those nerves under fluoroscopic guidance.

If your familiar pain substantially disappears for the duration of the anesthetic, the facet joint at that level is confirmed as the pain generator. If it does not, the facet joint is not the source — which is equally valuable information.

Diagnostic First, Therapeutic Second

This is fundamentally a diagnostic test. Its purpose is to determine whether you are a candidate for radiofrequency ablation, which provides durable relief by interrupting those same nerves.

Most protocols require two separate positive blocks on different days before proceeding to ablation. This double-block standard exists because a single block has a meaningful false-positive rate. Doing it properly means one extra visit; skipping it means a meaningful fraction of patients undergo an ablation that was never going to work.

Who It Helps

  • Axial low back pain without radiation below the knee
  • Pain worse with extension, standing, or twisting
  • Pain eased by sitting or forward flexion
  • Morning stiffness that loosens with movement
  • Tenderness over the paraspinal region
  • Degenerative facet arthropathy on imaging, correlated with symptoms

Confirming the Source at Remix Medical

There is no substitute for knowing precisely where pain originates. Contact Remix Medical to schedule a consultation with a board-certified pain management physician in Houston.

How it's performed

The patient lies prone under live fluoroscopy. After skin anesthesia, a fine needle is advanced to the junction of the transverse process and superior articular process at each target level, where the medial branch nerve runs. Correct position is confirmed radiographically, and a small volume of local anesthetic is deposited on each nerve. The patient then records pain scores over the following hours to establish whether the block was positive.

How to prepare

Do not take pain medication immediately before the procedure — it can obscure the diagnostic result. Arrange a driver. Hold anticoagulants only as directed by the prescribing physician. Bring a pain diary or be prepared to record pain scores for several hours afterward.

What to expect after

Record your pain level hourly for 8 hours after the block using a 0 to 10 scale, and bring the diary to your follow-up. Resume normal activity immediately — in fact, deliberately test the movements that usually hurt. Expect the relief to wear off as the anesthetic does. Report fever, spreading redness, or new weakness.

Outcome

A positive block — substantial short-term relief of the familiar pain — confirms the facet joints as the pain source and identifies the patient as a candidate for radiofrequency ablation, which typically provides 6 to 12 months of relief.

Your physician

Your pain management at Remix Medical.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

  • Raju Mantena, DO

    Pain Medicine Physician

    Medical Center — South Freeway · Montrose — Upper Kirby · Pearland

    Board certifiedAccepting newBook

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026.

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