The purpose of radiofrequency (RF) lesioning is to reduce or eliminate facet joint pain and related symptoms in the neck (cervical spine) or low back (lumbar spine). This procedure is also called radiofrequency rhizotomy or RF neurotomy. The goal of the procedure is to interrupt the communication of pain between a specific medial nerve root and the brain. The medial nerve roots supply the spine's facet joints.
Before an RF rhizotomy is performed, the pain-generating facet joint nerve(s) (medial branch nerves) is identified by means of a diagnostic injection, such as a facet joint or medial branch nerve block. Other tests may include MRI. Since the medial branch nerves do not control neck or low back muscles, disrupting or turning off their ability to send pain signals to the brain is not harmful.
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 downwards with a joint on the left and right sides of the vertebra. Facet joints are hinge-like and link vertebrae together.
A medial branch nerve innervates each facet joint. The medial branch nerves control sensation to the facet joint. Pain activates the medial branch nerve when there is degeneration or inflammation within a facet joint. These nerves do not control sensations or muscles in your arms or legs.
Patient Procedure Preparation
In advance of your procedure appointment, instructions are provided specific to you and the medications you regularly take.
Please notify the medical staff if you take blood thinning medication, such as Coumadin, Plavix, aspirin, etcetera. Certain drugs must be stopped several days before your procedure.
Possible Risks and Complications
Like other medical procedures, a radiofrequency rhizotomy (lesioning) may present risks. Complications include risk of infection, low blood pressure, headache and allergic reaction to medication.
What to Expect: The Procedure and After
If necessary, medications to relax you are given intravenously (IV). However, you will be awake during the procedure.
You are comfortably positioned in the operating room, and a cushion is placed under your chest or abdomen. Positioning and cushion placement is dependent on whether you are undergoing a cervical (neck) or lumbar (low back) procedure. Next, the skin area is cleaned with sterile soap. A local anesthetic is injected and given time to take effect.
Using fluoroscopic guidance (real-time X-ray), the doctor 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. The medial branch nerve is cauterized (burnt) as the electrode is heated. Once the procedure is completed, a small band-aid is applied to cover the injection site(s).
Depending on the number of spinal levels injected (usually two), the procedure takes 15 to 20 minutes. Afterward, the medical staff closely monitors you in the recovery area. Before you are released home, the medical staff provides you with written home care instructions.
Procedure Follow-up
We recommend you keep a daily journal of your pain level and other symptoms following your procedure. Please be specific and remember where pain and symptoms are related to the injection site. The pain diary will help you provide your doctor with detailed information about your treatment progress when you return for your follow-up office visit.