Lumbar Medial
Branch Block (LMBB)
Most of our patients have already gone through the rounds — PT, medications, maybe another injection that didn't do much. They're not short on treatment history. What they're short on is a real diagnosis. The LMBB is a targeted nerve block that tells us, with a high degree of certainty, whether your facet joints are the source. Not a guess. A confirmed answer.
Board Certified
Neurosurgeon
15+ Years
Experience
5000+
Procedures Performed
Get In Touch
Contact us today to schedule your consultation and take the first step toward relief.
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The Procedure
What Is a Lumbar Medial Branch Block?
Running along the back of your lumbar spine are small joints called facet joints. Each one has a dedicated nerve — the medial branch — that carries pain signals to your brain when those joints get inflamed, worn down, or injured.
The LMBB blocks those nerves specifically. It doesn't touch the spinal cord. No incisions, no stitches. A precise, imaging-guided needle deposits a small amount of anesthetic right at each nerve. The procedure is mainly diagnostic — if your pain shuts off after we block that nerve, we've just confirmed where it was coming from. Some patients also get a few days of meaningful relief as a side benefit, though that's not the primary goal.
"This is an injection in your lower back that targets tiny nerves coming from the joints in your spine, called facet joints. These joints can become painful over time due to arthritis or wear and tear or trauma.
Using live X-ray guidance, we place a small amount of numbing medication around these nerves. This procedure is mainly diagnostic, meaning it helps us confirm whether these joints are the source of your pain. It may also provide temporary relief. Your response helps guide the next step in treatment, which may include longer-lasting options. You will not feel the needle, as this injection is completed under LIGHT anesthesia."
— Capital Spine Institute, Procedure Overview That last part matters. You won't feel the needle. Light anesthesia means you're relaxed and comfortable — not knocked out, just at ease. Most patients walk out saying it was nothing like they expected. A lot of them had been dreading it for weeks.
30 Minutes
Same Day Procedure
General Anesthesia
2-6 Weeks Recovery
Who This Helps
Conditions the LMBB Is Used For
Facet joint pain shows up differently depending on what caused it. Some patients have decades of accumulated wear. Some had a car accident. Some just woke up one day and it never got better. These are the situations where we most commonly order an LMBB.
Facet Joint Syndrome
Deep aching low back pain that gets worse when you lean back, twist, or stand for any length of time. Usually doesn't shoot below the knee — that helps us separate it from a disc problem.
Lumbar Facet Joint Arthritis
Common in adults over 50, and honestly underdiagnosed. The pain can come and go or just grind along constantly. An LMBB tells us whether those arthritic joints are actually generating the symptoms.
Chronic Lower Back Pain
When pain has been there for months or years and nobody's given you a firm answer about why — the facet joints are one of the first places we look. A lot of chronic back pain cases are never properly worked up.
Post-Traumatic Facet Pain
Car accidents, falls, sports — they can damage the facet joints in ways that linger long after everything else has healed. The acute injury resolves. The joint pain doesn't.
Degenerative Disc Disease
As discs lose height, the facet joints pick up extra load. That load causes pain in a lot of patients — but DDD can have multiple pain generators running at the same time. The LMBB helps us sort out which one is doing the most damage.
Pain That Hasn't Responded to Other Treatments
If you've done PT, tried anti-inflammatories, maybe even had another injection — and nothing's really helped — it's worth asking whether anyone has actually confirmed the source. For most patients who end up here, the answer is no.
Why diagnosis has to come first
Not everyone with low back pain has facet joint pain. And here's the frustrating part: MRI and X-ray don't reliably answer that question. You can have serious degeneration on a scan and almost no pain from it. You can also have debilitating daily pain with imaging that looks pretty clean.
The LMBB sidesteps that problem entirely. It gives us a physiological answer — your body's actual response — rather than a visual one. That answer also determines whether radiofrequency ablation makes sense for you. Without a confirmed positive LMBB result, RFA isn't indicated.
WHY IT MATTERS
What the LMBB Actually Does for You
If you've been dealing with back pain for a while without a clear diagnosis,
Here's why the LMBB is worth knowing about.
01
You finally get a real answer
Scans give us pictures. The LMBB gives us a physiological response. Block the nerve, pain goes away — source confirmed. It's about as close to a definitive answer as you can get without surgery.
02
No surgery, no hospital admission
Outpatient procedure. No incisions. No general anesthesia. You're home the same day, usually within a couple hours of walking in.
03
Often comes with real short-term relief
Diagnosis is the main goal, but the numbing agent frequently provides a real window of relief. For people who've been hurting for months, even a day or two off can feel significant.
04
Opens the door to lasting treatment
A positive result qualifies you for radiofrequency ablation — relief that can last a year or more. Most insurance plans also require a confirmed LMBB before approving RFA. So this isn't just diagnostic, it's the prerequisite.
05
Quick, with minimal downtime
In under an hour start to finish. Most people are back to light activity the next day. There's not much recovery to speak of.
06
Live imaging every time, not sometimes
Every LMBB here uses real-time fluoroscopy. The needle goes exactly where it needs to go. That accuracy is what makes the diagnostic result actually mean something.
Ready to find out what's actually causing your back pain?
Schedule a consultation with our Northern Virginia spine specialist. We'll start with a thorough review and take it from there.
What Happens During the LMBB
Check-In and Pre-Procedure Review
You'll arrive at our office and we'll go through your history, medications, and any imaging you've brought. IV line goes in, light sedation is administered. By the time you're lying on the procedure table, most patients feel completely relaxed — not out cold, just genuinely comfortable.
Getting Positioned
Face down on a padded table. The lower back is cleaned and draped. The fluoroscopy unit — live X-ray — gets positioned so the physician has a real-time view of your lumbar spine from start to finish.
Placing the Needle Under Live X-Ray
Under live fluoroscopy, a fine needle is guided to the medial branch nerve at each level being treated. The physician is watching where it goes the whole time — this isn't a blind injection. You won't feel it because of the sedation.
Delivering the Medication
A small, measured amount of local anesthetic goes right at the nerve — blocking its ability to carry pain signals from the facet joint. Small volume on purpose. Accuracy matters more than quantity here. Depending on your situation, a low-dose anti-inflammatory may be added.
Recovery and Pain Tracking
30 to 60 minutes in the recovery area. This window is actually the most important part of the procedure — you'll be noting your pain level as the anesthetic takes effect. Did it change? By how much? That data is the whole point. You'll take a simple pain diary home and track the next day or two as well.
Going Home and Planning What's Next
You need a driver home, but that's about the only real restriction for the rest of the day. Light activity is fine pretty quickly. We schedule a follow-up within one to two weeks — that's where we review your pain diary together and talk through what the results mean. If you get meaningful relief, the facet joints are confirmed as the source, and we discuss what to do about it long-term.
What to expect week by week
Recovery varies, but here's how most patients progress.
Same Day
Go home. Rest.
Procedure done. Mild soreness at the injection site is normal. Skip driving — you'll need a ride.
24–48 Hours
Soreness fades.
Site soreness clears in a day or two. Some patients notice early pain improvement starting here.
1 Week
You should feel a difference.
Most patients see a meaningful reduction in neck and arm pain as the steroid reaches full effect.
Weeks–Months
Continued improvement.
Relief can last weeks to months. A second injection or PT can extend it further if needed.
Is This Right for You?
Who Is a Good Candidate for the LMBB?
The LMBB isn't right for everyone with back pain. But for the right patient, it's often the single most useful diagnostic step available. You're probably a good candidate if:
You've had persistent low back pain for three months or longer
Pain is centered in the lower back, sometimes spreading to the buttocks or upper thighs
It gets worse when you arch back, twist, or stand for a while
PT and medications haven't made a real dent in it
Imaging shows facet joint degeneration, arthritis, or joint changes
You've had a back injury — car accident, fall, work-related trauma
You want a confirmed diagnosis before committing to anything more involved
This Procedure May Not Be Appropriate If You Have:
- An active infection — at the site or systemic
- A bleeding disorder or anticoagulant use without clearance
- A known allergy to local anesthetics or contrast agents
- Back pain primarily from disc herniation with nerve root compression
- Pregnancy
Not sure where you fall? The consultation is exactly where we sort that out. Our team will go through your history, look at your imaging, and give you a straight answer.
What Makes Capital Spine Institute Different
Patients come to us from across Northern Virginia, Alexandria, and Falls Church — a good portion of them having already tried other providers.
Here's what tends to stand out.
Neurosurgical training in an outpatient setting
Our lead physician is board-certified in neurosurgery. That training changes how procedures get done. Image guidance, anatomical precision, no shortcuts — the same standards carry over from the OR into this office.
Fluoroscopy is non-negotiable here
Some practices do medial branch blocks without imaging guidance. We don't. Live X-ray is used on every single LMBB at this practice. That's not a selling point — it's just how it should be done.
We actually listen
A lot of our patients have been through treatments that didn't work. Often it's because no one took the time to understand the full picture. Your consultation is a real conversation — not a 10-minute intake.
We don't push procedures
The LMBB itself reflects this. It's a diagnostic step, not a commitment to anything bigger. We want to know what's actually going on before recommending any treatment — let alone surgery.
Close to where you live
Offices in Northern Virginia, Alexandria, and Falls Church. For most patients, this isn't a trek. Expert spine care shouldn't mean a two-hour round trip.
One practice, all the way through
Consultation, procedure, follow-up, and ongoing management — all under one roof. No referrals to a different office. No dropping the ball between handoffs.
Expert Spine Surgeon
Dr. Avery L. Buchholz is a board-certified neurosurgeon with fellowship training in complex spine surgery. With over 15 years of experience and 5,000+ procedures performed, he specializes in both minimally invasive and complex surgical techniques.
His expertise spans the full spectrum of spine care, from non-surgical interventions to advanced reconstructive procedures, always prioritizing patient safety and optimal outcomes.
Frequently Asked Questions
Get answers to common questions about our practice and procedures
How long does the whole thing take?
The injection itself is 20 to 30 minutes. With check-in, prep, and recovery, most patients are at the facility for two to three hours total. Same-day discharge.
Will I actually feel the needle?
No. You’re under light anesthesia for the whole procedure — relaxed, comfortable, not deeply sedated. Most patients say they barely registered that anything happened. “That was it?” is genuinely something we hear a lot.
How do I know if it worked?
You track your pain in the hours after the injection. If you get meaningful relief — generally 50% or more reduction from your usual level — that’s a positive diagnostic result. Your pain diary is what we go over at follow-up to confirm it.
Is this the same as an epidural steroid injection?
No — they target completely different anatomy. An epidural goes into the epidural space and is used for disc herniation and nerve root compression. The LMBB targets the small nerves that supply the facet joints specifically. Different purpose, different location, not interchangeable.
What if my pain doesn’t improve after the injection?
A negative result is still useful. It means the facet joints probably aren’t the primary driver — which points us somewhere else. Not every patient gets relief, but every patient gets data.
Can it be done at more than one spinal level?
Yes. Depending on your symptoms and imaging, the injection may cover one or several lumbar levels in the same session. That determination gets made at your consultation based on your clinical picture.
Does insurance cover this?
Many plans do, particularly for patients who’ve already gone through conservative treatment without adequate relief. Coverage varies. Our team checks your benefits ahead of time and walks you through costs before your procedure date — no surprises.
What’s the difference between this and radiofrequency ablation?
The LMBB comes first. It uses anesthetic to confirm the pain source. Radiofrequency ablation uses heat to interrupt the nerve’s ability to signal pain — and can provide relief for a year or more. But RFA is only performed after a confirmed positive LMBB result. One has to come before the other.
TAKE THE NEXT STEP
Your back pain deserves a real diagnosis — not another round of guessing.
If you’ve had chronic lower back or facet joint pain and haven’t gotten a straight answer yet, Capital Spine Institute in Northern Virginia can help. Call or request an appointment below.
Our Locations
Serving patients across VA and the DC area
Falls Church, VA
6400 Arlington Blvd, Suite 710
Open
Alexandria, VA
6244A Little River Turnpike
Open
Richmond, VA
Address coming soon
Opening Soon
Charlottesville, VA
Address coming soon
Opening Soon
Washington, DC
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Opening Soon
Get In Touch
Contact us today to schedule your consultation and take the first step toward relief.
Address
6244 Little River Turnpike, Suite 101
Alexandria, VA 22312
Phone
FAX
Office Hours
Monday - Friday: 9:00 AM - 6:00 PM
Saturday: 9:00 AM - 6:00 PM
Sunday: Closed
This form is intended for scheduling purposes only and is not a HIPAA-compliant form. Please avoid sharing any sensitive medical information.
By submitting, you consent to being contacted using the information provided.
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