The purpose of radiofrequency (RF) rhizotomy, or RF neurotomy, is to reduce or eliminate facet joint pain and related symptoms in the neck (cervical spine) or low back (lumbar spine). The goal of the procedure is to interrupt communication of pain between a specific medial nerve root and the brain. The medial nerve roots innervate the spine’s facet joints.
Before a RF rhizotomy is performed, the facet joint nerve(s) (medial branch nerves) causing the pain is identified by means of a diagnostic injection, such as a facet joint or medial branch nerve block. Other tests may include MRI scan. Since the medial branch nerves do not control neck or low back muscles, it is not harmful to disrupt or turn off their ability to send signals to the brain conceived as pain.
RF neurotomy is a precisely targeted injection that works by creating heat to destroy a facet joint’s medial nerve. Relief from pain and related symptoms may last a year or longer. However, the medial nerve root regenerates (grows back) and facet joint pain may come back.
Basic Facet Joint Anatomy
Each vertebra in the cervical (neck), thoracic (chest), and lumbar (low back) has two sets of facet joints at the back of the spine. One pair faces upward and one downward with a joint on the left and right sides of the vertebra. Facet joints are hinge-like and link vertebrae together.
Each facet joint is innervated by a medial branch nerve. The medial branch nerves control sensation to the facet joint. When there is degeneration or inflammation within a facet joint, pain activates the medial branch nerve. These nerves do not control sensations or muscles in your arms or legs.
Patient Procedure Preparation
Before the procedure, the patient will be asked about medications that he or she takes regularly. Certain drugs must be stopped several days before your procedure.
Possible Risks and Complications
A radiofrequency rhizotomy, like other medical procedures, carries with it certain inherent risks. Rare but potential complications include risk of infection, low blood pressure, headache, and allergic reaction to medication. The physician will discuss with the patient the risks and benefits of an RF rhizotomy for that partient.
What to Expect: The Procedure and After
The patient is awake during the procedure, but an intravenous line may be placed to deliver calming medication to the patient. In the operating room, the patient will be positioned with cushions for comfort and to give the physician free access to the neck (cervical) or lower back (lumbar) region, as appropriate. Next, the skin area is cleaned with a sterile soap. A local anesthetic is injected and given time to take effect.
The procedure relies on fluoroscopy, a type of video X-ray that projects X-ray images onto monitors in the procedure room. The C-arm (named for its characteristic C-shape) is positioned over the patient. Using the fluoroscope, the physician precisely positions the needle with an electrode tip beside the target medial branch nerve. Next, by means of the electrode, radiofrequency technology (mild electrical current) stimulates the medial branch nerve. As the electrode is heated, the medial branch nerve is cauterized (burnt). When the procedure is completed, a small bandage is placed at the injection site.
This procedure may be done at more than one spinal level. Typically, two levels are done but more may be required. The whole procedure usually lasts about 15 to 20 minutes. After the procedure, the patient is brought to the recovery area where a nurse monitors his progress. At discharge, the patient is given written instructions regarding home care.
The physician’s office usually calls the patient 24 to 48 hours after an RF rhuizotomy to check on the patient. In some cases, the patient may be asked to keep a pain journal with symptoms and activities. Such journals can be of great value in fine-tuning therapy if they describe symptoms in relationship to the injection site.
Conclusion
A radiofrequency (RF) rhizotomy (RF neurotomy) has provided significant pain relief for many people suffering from moderate to severe chronic neck or low back pain. The procedure often brings relief for up to a year, but may have to be repeated periodically because if the damaged nerve grows back, the pain may return. Not all people with neck or low back pain are appropriate candidates for RF rhizotomy (RF neurotomy).