Radiofrequency (RF) Rhizotomy –RF Neurotomy

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The purpose of radiofrequency (RF) rhizotomy, or RF neurotomy, is to reduce or eliminate facet joint pain and related symptoms in the neck (cervical spine) or low back (lumbar spine).  The goal of the procedure is to interrupt communication of pain between a specific medial nerve root and the brain.  The medial nerve roots innervate the spine’s facet joints.

Before RF rhizotomy is performed, the facet joint nerve(s) (medial branch nerves) causing the pain is identified by means of a diagnostic injection, such as a facet joint or medial branch nerve block.  Other tests may include MRI scan.  Since the medial branch nerves do not control neck or low back muscles, it is not harmful to disrupt or turn off their ability to send signals to the brain conceived as pain.

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 downward with a joint on the left and right sides of the vertebra.  Facet joints are hinge-like and link vertebrae together.

Each facet joint is innervated by a medial branch nerve.  The medial branch nerves control sensation to the facet joint.  When degeneration or inflammation affects a facet joint, pain activates the medial branch nerve.  These nerves do not control sensations or muscles in your arms or legs.

Patient Procedure Preparation

The physician instructs the patients which drugs and supplements to stop and when well in advance of the procedure date.

Possible Risks and Complications

A radiofrequency rhizotomy, like other medical procedures, has potential risks. Rare but potential complications include infection, low blood pressure, headache, and allergic reaction to medication. The physician discusses the risks and benefits of an RF rhizotomy with the partient.

What to Expect: The Procedure and After

Relaxing medication is administered through an intravenous line.  The patient is awake and able to talk with the physician during the procedure.  The patient is positioned on the procedure with cushions for support and comfort giving the physician access to the neck (cervical) or lower back (lumbar) region. The skin area is cleaned using a sterile solution.  A local anesthetic is injected and given time to take effect.

The C-arm (named for its characteristic C-shape) is positioned over the patient. Using the fluoroscope, the physician  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.  As the electrode is heated, the medial branch nerve is cauterized (burnt). When the procedure is completed, a small bandage is placed at the injection site.

The procedure may be performed at more than one spinal level. Typically, two levels are treated but more may be necessary. The procedure takes about 15- to 20-minutes. After the procedure, the patient is wheeled into the recovery area and a nurse monitors vital signs. Written instructions about home care is provided at discharge.

The physician’s office follows up with the patient by telephone during the next 24- to 48-hours after RF rhuizotomy. The patient is instructed to keep a pain journal to track symptoms. Such a journal helps to fine-tune therapy.

Conclusion

  • A radiofrequency (RF) rhizotomy (RF neurotomy) provides significant pain relief to many patients with moderate to severe chronic neck or low back pain.
  • RF rhizotomy may relieve pain for up to one year, but may periodically be repeated when the damaged nerve grows back causing pain to return.