Rhizotomy

Thoracic Facet Joint Rhizotomy / Radiofrequency Ablation

Generally speaking, if you have experienced pain relief from a nerve block injection, you may be a good candidate for radiofrequency ablation, also referred to as a rhizotomy. The term “ablate” means to burn the nerve which is causing you pain, eliminating the pain signals to the brain. Radiofrequency ablation uses an electric current to heat up a small section of the nerve that goes to the facet joint in order to stop the pain signal. This minimally invasive procedure can provide relief that will last for months for people with chronic pain due to arthritic joints.

How is radiofrequency ablation performed?
 

The doctor will numb your skin with an anesthetic. Then, guided by an x-ray, he will:

  • Insert a thin needle into your neck and look at the placement under x-ray

  • Next, a small electrode will be inserted through the needle to the target location.

  • Before the burning is started, we use a process to test the needle placement to ensure that the correct nerve is being burned. A small electrical current is used to burn the nerve

Usually, the procedure takes 15-20 minutes and you can go home the same day.

The lumbar facet joints are small joints located at the back of the spine. There is a pair at each level of the spine, which can undergo degenerative changes similar to knees, hips and shoulder joints. They are responsible for 30% of cases of back pain and the percentage increases with advancing age. Facet joint Osteoarthritis is similar to that which occurs in knees and hips. It involves damage to the cartilage, meniscal, ligaments and bone spur formation, which results in pain.

This illustration shows the facet joint cartilage is irregular with inflammatory changes, which are typical of osteoarthritis and mechanical back pain.

Unlike knees and hips there are no operations to replace the facet joints and they are too small to undergo arthroscopic repair. Intra-articular cortisone injections can provide pain relief but often last for a short period of time.

Facet joint pain can be relieved by a minor surgical procedure called facet joint rhizotomies or radiofrequency neurotomy, which is a procedure that involves inserting a needle onto the nerve that carries the pain signals from the joints. An electric current is applied that cauterizes the nerve.

This picture shows the needle and electrode in position on the medial branch nerve to the facet joint. Passing the electric current damages the nerve so that it no longer transmits the pain signal to the spinal cord and on to the brain.

Facet joint rhizotomy is a minimally invasive procedure that is performed under local anesthetic and x-ray guidance. A needle is inserted into the back and directed onto the medial branch nerves that supply the joint. Local anesthetic is injected onto the nerve so that the person does not experience pain during the procedure. An electrode is inserted into the needle and an electric current is applied which heats the tissue around the needle and cauterizes the nerve creating damage that prevents the pain signal from getting to the spinal cord and brain. Facet joint rhizotomies have a 70 to 80 % success rate in reducing or eliminating back pain. This usually lasts for a year or more. The nerves can regenerate and pain can recur. If this happens the procedure can be repeated.

Potential complications include infection and nerve root injury, which could cause numbness or weakness in a leg. However this is very uncommon. People usually experience pain from the procedure that can last for a few days. After that their pain is significantly improved or completely alleviated. Most people are able to reduce their pain medication and return to normal activity.

Facet joint pain is diagnosed by injecting local anesthetic onto the medial branch nerves under x-ray guidance. When the nerves to the painful joint are anesthetized the pain is immediately relieved. Once the painful joints have been identified then a rhizotomy can be performed to provide long-term pain relief.

A sacroiliac (SI) joint rhizotomy is intended to provide pain relief by blocking the pain signals that the nerves joints send to the brain. This procedure is reserved for those who have already had at least two injections (lateral branch blocks or sacroiliac joint injections) and have identified the exact source of their pain. Duration 30 minutes How is it performed? Prior to the ablation, you will be positioned on your stomach. The site of the injection will be cleaned, and your physician will administer a dose of local anesthetic to numb the area. Under the guidance of fluoroscopic x-ray, your physician will insert a needle with an electrode at the tip alongside the nerves (lateral branches) to the SI joint. Using radiofrequency, the electrode is heated and destroys the nerve ending, which blocks the pain signals from reaching the brain. This will need to be done twice or perhaps more depending on the number of sites to be treated. Your vital signs will be monitored for the duration of the procedure. Prior to your procedure You will have the option of receiving no sedation or: • oral sedation – or – • intravenous sedation If choosing sedation, you must not eat for six hours or drink anything for four hours before the procedure.

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