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Rhizotomy

Radiofrequency Rhizotomy is a minimally invasive procedure used to treat pain by sending radio waves through a needle to the selected medial branch nerves causing pain in order to interrupt the pain signals. 

Medial branch nerves are very small nerves that innervate the facet joints of the spine. Facet joints are the joints connecting the different vertebra of the spine to each other. The joints are present on both sides of the spine from the neck to the lower back.

Indications

Radiofrequency Rhizotomy is indicated if a diagnostic procedure called medial branch block is successful in confirming the patient’s back pain is originating from the facet joints. 

Medical branch block is an injection of a local anesthetic directly near the medial branch nerve to temporarily block the pain signal carried from the facet joints to the brain. It is a diagnostic tool and provides only temporary relief from pain.  It is used to assist your physician in diagnosing the cause of your back pain.

After the medial branch block your pain may

  • go away for a few hours
  • a few days or
  • not reduce at all

If the pain is relieved after the medial branch block, this indicates that the origin of the pain is the medial branch nerves that were numbed. Your doctor may then recommend radio-frequency rhizotomy to relieve the pain for a longer period of time.  Nerves regenerate over time so pain relief can vary from a few months to a couple years.

Procedure

Radiofrequency Rhizotomy is an outpatient pain management procedure.  You will be taken to the pre-op area where trained nursing staff will get you ready for the procedure, by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lie face down on a table for treatment of lower back pain or on your back if the neck area is being treated.

An intravenous or IV line may be inserted to give you medicine to help you relax.  The injection site is then cleansed and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.

A thin hollow needle is then inserted to reach the medial branch nerve to be treated. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.

When the doctor is satisfied with the position of the needle, a special needle tip with an electrode is inserted through the hollow needle in the spine.

Using electrical stimulation, the doctor verifies the correct nerve to be treated. You will feel some tingling in the area at this time. 

Once the doctor is satisfied the correct nerve is located and the tissues around the tip of the needle are heated with an electric current for a minute or two.

The needle is removed and the injection site is covered with a dry, sterile bandage. The procedure takes about 15-20 minutes to complete but may take longer depending on the number of nerves required to be treated.

Risks and Complications

With the use of live imaging though fluoroscopic X-ray and physicians trained in the latest interventional techniques, complications are rare. But with all medical procedures, complications may occur.  To help minimize risks please follow all directions given to you by your care provider.  Have all your treatment options explained so you are aware of the risks and benefits of these procedures. 

Some complications may include:

  • Infection: Your pain physician cleans and sterilizes your back before every procedure to prevent this from occurring. On rare occasions, oral antibiotics may be needed.
  • Allergic reaction: This may occur if you have allergies to any medication used. Typically, this is pretreated and on occasion your physician may recommend medications for you to take after the procedure. Pay close attention to any rashes and difficulty breathing because that may indicate need for emergency attention.
  • Increased pain may occur after the procedure in the area where the needles were placed. This may last up to a week or rarely longer. However typically it resolves completely.
  • You may also experience an area of numbness, usually in the area which was originally painful.
  • The procedure may take up to 6 weeks for complete benefit, so improvement may not be immediate.

You will need someone to drive you home once you are discharged.  As always, follow the instructions of your care provider and have your questions answered prior to the procedure.