The facet joints are often the primary source of pain for many back pain sufferers. Facet joints are small joints located in pairs on the back of the spine that provide stability to the spine and allow the spine to move and be flexible.
Depending on where the problematic facet joints are located, they can cause pain in the mid-back, ribs, chest (thoracic facet joints), lower back, abdomen, buttocks, groin, or legs (lumbar facet joints), neck, shoulders, and even headaches (cervical facet joints).
Facet joint injections of steroid medications are often given to patients with this type of pain. The injections not only provide pain relief, but they can also help the physician pinpoint exactly where the pain originates and can confirm or reject the facet joints as the source of the pain. For many patients, facet joint injections provide adequate relief. For others, however, the pain relief is too short-lived. For these patients, facet rhizotomy (also called radiofrequency rhizotomy) may be the answer.
What Is Facet Rhizotomy?
The goal of a facet rhizotomy, either a cervical facet rhizotomy or lumbar facet rhizotomy, is to provide pain relief by “shutting off” the pain signals that the joints send to the brain. The pain relief experienced by most patients who have this procedure lasts months or even years.
How Facet Rhizotomy Is Done
Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed alongside the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.
Serious complications with facet rhizotomies are rare. A new technique using pulsed radiofrequency does not actually burn the nerve, but appears to stun the nerve. This technique appears to be even safer than the regular radiofrequency technique, but does seem to have the drawback of not lasting quite as long. Some specialists (such as the author) prefer to use the pulsed technique in higher risk areas such as the neck.
The procedure takes about 30-60 minutes. Afterwards, patients are monitored for a short time before being released.
A facet rhizotomy may help to relieve pain by “turning off” the pain signals the spine’s facet joint(s) send to the brain. To help you prepare for the procedure:
Facet JointsYour physician will give you detailed instructions about whether you can eat before the procedure.
In most cases, you can continue to take your usual medications before a rhizotomy. However, make sure you discuss what medications you use with your physician before the procedure.
Since a rhizotomy requires the use of a local anesthetic, you may need someone to drive you home after the procedure.
About the Procedure
The procedure begins with a mild sedative administered intravenously(by IV) to keep you comfortable but awake during the procedure. A local anesthetic is injected to numb the procedure site.
Your pain physician utilizes fluoroscopy (real time x-ray)to guide placement of the needle (electrode). Once the needle is in place, a mild electrical current stimulates the nerve and confirms its exact location. You may feel slight pressure or tingling during this part of the procedure. Then the electrode is heated to deaden the sensory nerves. When the procedure is completed, the needle is removed and the injection site is bandaged.
After the Procedure
You may experience some discomfort immediately after the procedure, such as bruising, soreness, or swelling at the injection site. Most patients are able to return to work and/or their normal daily activities the day following a facet rhizotomy.
Your back may be sore for a few days after the procedure. Usually cold therapy (eg, ice pack) and/or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) help ease post-procedure symptoms. Soon, you should begin to notice an improvement in your usual pain. Improvement usually continues during the next several weeks.
Serious Complications are Rare
As part of your post-procedure instructions for recovery at home, your physician provides additional contact information should you experience any of the symptoms listed below. Should you experience any one of these symptoms, quickly contact your physician.
- Prolonged pain at the injection site
- Numbness that lasts more than 2-3 hours
- Bleeding or drainage at the injection site