Chronic low back pain often originates from the facet joints in the lumbar spine, critical for stabilizing the spine. These joints, when irritated, can cause pain radiating to the hips or buttocks. Typically, standing, twisting, or bending backward can intensify the pain, while sitting or lying down provides relief.

Diagnosis starts with a physical exam, possibly followed by imaging tests like X-rays or MRI. Since these tests may not always pinpoint the problem, healthcare providers often use diagnostic injections, called medial branch blocks, to target the nerves from the facet joints, confirming the pain's source by observing the patient's response, usually done twice, with weeks in between.

Initially, conservative treatments like physical therapy and bracing are tried. If these are ineffective, an advanced nerve avulsion procedure might become an option. This minimally invasive technique involves making several small incisions over the affected area. A specialized tool is guided, often using imaging like X-ray, to disrupt or "avulse" the medial branch nerves responsible for sending pain signals. This precisely disrupts the pain-carrying nerve pathways in the lower lumbar spine.

The procedure typically lasts 15 to 30 minutes, possibly an hour for complex cases, and requires only local anesthesia, though sedation might be needed. If sedation is used, solid foods should be avoided eight hours before, with clear liquids allowed up to two hours prior. Inform the healthcare team about blood thinners, as they may need pausing to reduce bleeding risks. There are small risks of bleeding, infection, or temporary numbness, and rare cases of permanent nerve injury. Sutures might be needed based on the provider's discretion.

Considerable relief may take up to a month, but many experience months to a year or more of relief. Physical therapy can start 4 to 6 weeks after to enhance results. Alternatives include radiofrequency ablation, physical therapy, and bracing, with spinal cord stimulation as a last resort if other treatments fail.