Greater Texas Orthopedic Associates
A pain specialist performing a fluoroscopy-guided medial branch block

Medial Branch Blocks

An image-guided diagnostic block of the small nerves that carry sensation from the facet joints, used to assess whether they may contribute to predominantly axial neck or low back pain.

Role
Diagnostic
Target
Medial branches
Guidance
Fluoroscopy
Access
6 Texas clinics
JHMedically reviewed by Dr. John Hall, Pain Management SpecialistLast updated July 2026
Quick overview

Who We Help

Two audiences read this page: the patient considering a diagnostic block and the professional coordinating the related care or claim.

Injured patients

Patients with predominantly axial neck or low back pain whose clinician is evaluating whether facet-joint nerves may be appropriate diagnostic targets.

Attorneys and case managers

Firms coordinating a spine-injury claim that need the clinical indication, targeted levels, baseline findings, measured response, and follow-up plan documented clearly.

Overview

What Is a Medial Branch Block?

Facet joints receive sensation from small nerve branches called medial branches. During a medial branch block, a clinician places a small amount of local anesthetic near selected nerves under fluoroscopic guidance and then assesses pain and function during the expected anesthetic window.

The block is primarily diagnostic, but it does not establish a pain source by itself. No single history, examination, imaging finding, or response threshold is universally definitive. The clinician interprets the response with the full record and applicable criteria before considering radiofrequency ablation or another pathway.

Dr. John Hall, Pain Management Specialist
Conditions

When a Medial Branch Block Is Used

A medial branch block may be considered after clinical assessment identifies a possible facet-mediated pain source and other explanations are reviewed.

Suspected facet-mediated neck or back pain
Predominantly axial neck or low back pain
Pain that affects daily function
Pain aggravated by extension or rotation
Symptoms persisting after conservative care
Assessment before possible radiofrequency ablation
The procedure

How a Medial Branch Block Works

The target levels, anesthetic, preparation, and response-measurement plan are confirmed before the procedure.

1

Selecting the levels

The clinician reviews symptoms, examination findings, imaging, prior care, and alternative explanations before selecting the region, level, and side.

2

Baseline pain score

Pain and function are documented before the block using the assessment plan chosen by the treating clinician.

3

Fluoroscopic needle placement

The physician uses fluoroscopic imaging to guide each needle toward the intended bony target; contrast may be used when appropriate.

4

Anesthetic injection

A small amount of local anesthetic is placed near each targeted medial branch according to the clinical plan.

5

Response assessment

The patient follows individualized activity and pain-tracking instructions. The clinician compares the response with baseline before recommending another diagnostic block, ablation, or a different plan.

Practical details

What to Expect

Preparation and follow-up vary by target region, medical history, medication, facility instructions, and payer criteria.

Visit
Outpatient

The team confirms check-in, medication, fasting, and transportation instructions before the appointment.

Guidance
Image guided

Fluoroscopy is used for placement; contrast may be used unless contraindicated.

Response
Temporary

Any change in usual pain and function is assessed during the expected anesthetic window.

Next step
Clinician guided

The treating clinician applies the clinical record and relevant criteria before recommending further care.

Outcomes

Potential Benefits, Risks, and Recovery

The clinician reviews the diagnostic purpose, alternatives, limitations, and patient-specific risks before treatment.

1Benefits

May provide information about a possible facet-mediated pain sourceMay help identify levels for further evaluationCan inform whether radiofrequency ablation should be consideredDocuments baseline and assessed response

2Risks

Temporary soreness at the needle sitesShort-lived numbness in the treated areaTemporary change in sensation or painBleeding, infection, allergic reaction, or nerve irritation

3Recovery

Activity follows the discharge instructionsMedication guidance is individualizedPain and function tracking is completed when requestedFollow-up timing is set by the treating clinician
When to call us. Contact the clinic promptly for fever, spreading redness, drainage, or worsening pain after the procedure. Seek urgent care for new weakness or numbness, loss of bladder or bowel control, severe headache, or other rapidly worsening neurological symptoms.
Referral workflow

Referral, Documentation, and Communication

GTOA coordinates referral intake, scheduling, available records, and status communication for patients and authorized legal teams.

Initial evaluation report

History, mechanism of injury, examination findings, diagnosis, and the proposed treatment plan.

Clinical and imaging context

Available imaging is considered alongside symptoms, examination findings, prior care, and alternative pain sources.

Clinical correlation

When clinically appropriate, documentation may discuss how the reported incident, findings, and pre-existing conditions relate.

Block and response record

Targeted levels, approach, image guidance, medication, tolerance, baseline findings, and clinically assessed response are documented as appropriate.

Future care recommendations

The clinician may document another diagnostic block, rehabilitation, ablation, or a different pathway when supported by the record.

Response times

Scheduling and records timing depend on location, clinical need, authorization, record availability, and clinician review. The team confirms the next step for each request.

Referral requestReviewed by the team
SchedulingBased on clinical and authorization needs
Procedure notesAvailable after clinician review
Records requestsConfirmed for each request
Status communicationProvided at key milestones
Cost & coverage

Insurance, Payment, and Case Coordination

Coverage and payment arrangements vary. Contact the team before scheduling so eligibility, authorization, and current options can be confirmed.

Health insurance

Contact GTOA to verify current plan participation, benefits, and any authorization requirements before the procedure.

Confirm eligibility

Qualified injury cases

Lien-based arrangements may be available for qualifying personal injury cases. The team confirms eligibility and terms for each referral.

Lien review

Self-pay

Patients paying directly can contact the office for current pricing and available payment arrangements.

Ask the team
Why GTOA

Why Choose GTOA?

The same six reasons matter to a patient choosing a clinic and to a firm choosing where to send a client.

01

Clinical assessment first

Symptoms, examination findings, available imaging, prior care, and alternative pain sources are reviewed before a block is recommended.

02

Image-guided placement

Medial branch blocks are performed with fluoroscopic guidance; contrast may be used when appropriate.

03

Measured response

Baseline pain and function are compared with the response during the planned anesthetic window.

04

Clear procedure record

Documentation can identify the indication, targeted levels, approach, guidance, medication, response, and follow-up plan.

05

Coordinated communication

Patients and authorized legal teams can contact GTOA about scheduling, status questions, and available records.

06

Six Texas clinics

Beaumont, Houston, San Antonio, Dallas, Arlington, and Corpus Christi provide access to GTOA care across Texas.

Department

Pain management

Other departments

Request care or refer a client

Patients can request care through Contact Us, and legal teams can begin a referral through the For Attorneys page.

Request an evaluationRefer a client
Main branch(409) 600-8707
Medical review

Medial branch block specialist

The physician responsible for the medical review of this page.

Dr. John Hall

Dr. John Hall

Pain Management Specialist

Our branches

Find a clinic near you

Corporate office: 324 North 23rd Street, Beaumont, TX 77707

FAQ

Frequently Asked Questions

Still have questions?

Call us at (409) 600-8707

For patients

The temporary response can provide diagnostic information about the targeted medial branch nerves. The clinician interprets it with symptoms, examination findings, imaging, prior care, and the planned activity test.

For attorneys and case managers

A small amount of local anesthetic is placed near selected medial branch nerves under image guidance, and the response is measured against baseline. False-positive and false-negative results remain possible, so the full record matters.