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Rhizotomy

Radio-Frequency Lesioning

WHAT IS RADIOFREQUENCY LESIONING?

Radiofrequency lesioning is a simple and safe treatment for Facet Joint degeneration. It is performed as an outpatient procedure in an operating room under fluoroscopic (x-ray) guidance and mild sedation. Using a specialized machine, pain signals to the specific areas of the spine involving the nerves to the facet joints are interrupted. Clinical data shows that this method is effective in providing lasting pain relief. Patients are encouraged to resume normal activities at their pace after the procedure.

WHAT ARE FACET NERVES?

Facet nerves are small nerves that branch out from larger spinal nerves exiting the spine. These nerves contain mostly sensory information. The nerves supply the facet joints, ligaments, skin, and small muscles at each segment. These are NOT the nerves that are responsible for movement of the extremities and sensation in the extremities.

WHY DO FACET JOINTS BECOME DISEASED?

The reason is unclear. The facet joints have been shown to be load bearing and stabilizing effect that prevents excessive rotation or forward slippage of the vertebral bodies. Stresses on the facet joints can occur by sudden or repeated lifting and twisting motions of the lower back or neck leading to irritation or injury. In the older population, arthritic changes may play a role in the development of facet syndrome.

HOW IS THE PROCEDURE PERFORMED?

Radiofrequency lesioning is performed in an operating room setting as an outpatient. You will be lying on your stomach. Both local anesthesia and a mild sedative may be used to minimize any discomfort during the procedure. Your cooperation is necessary during the sensory and motor stimulation process to aid in properly placing the lesioning electrode. Fluoroscopic control (x-ray guidance) is used to help ensure safe and correct placement of the needle. Once the needle is in the exact target area, a microelectrode is inserted through the needle to begin the stimulation process. During this process, your physician will ask you if you feel a tingling sensation. If there is stimulation down an extremity, the needle is moved to a different location before lesioning. When you feel stimulation locally and x-ray position is acceptable, lesioning is then performed. A small amount of current will travel through the electrode into the surrounding tissue and eliminate pain pathways. The procedure can take from about twenty minutes to a couple of hours. After the procedure, you will need a ride home. We advise patients to take it easy for a day or so after.

IS THE PROCEDURE PAINFUL?

You may feel some uncomfortable sensations at times during the testing phase. You will receive sedation during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Ice packs the first day usually will control any discomfort. After the first week is over, your pain may be decreased or gone completely.

WILL I HAVE TO TAKE TIME OFF FROM WORK?

Radiofrequency treatments will not limit your daily activities. You should be able to resume all your normal activities including work as soon as you feel able.

ARE THERE ANY RISKS OR SIDE EFFECTS FROM THE PROCEDURE?

Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. Because the procedure is performed under x-ray control and patients are awake, the risk of large nerve injury is very small. Nerve stimulation is performed prior to lesioning so that large nerves that supply the extremities are not damaged.

WHO SHOULD NOT HAVE THIS PROCEDURE?

If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks of the facets, you may not be a candidate for this procedure

HOW LONG DOES PAIN RELIEF LAST FOLLOWING THE PROCEDURE?

Only small peripheral sensory nerves are lesioned with this procedure. These nerves do have the capacity to grow back. Patients may require repeat lesioning as early as 6 months gut some may also have long-term relief as well. The nerves are usually blocked for 6-9 months but can last as long as 18 months.

WHAT ARE THE BENEFITS OF RADIOFREQUENCY LESIONING?

Because the procedure disrupts nerve conduction (pain signals) it may in turn reduce your pain and other related symptoms. Approximately 70-80% of patients will get a good block of the intended nerve. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well.

Your physician will determine your response to the procedure. As with any other procedure, the risks, benefits, and alternatives should be disscussed. After the procedure, your spinal specialist will guide you with further evaluations and recommendations.