Facet Neurotomy (Rhizotomy)

This procedure uses a radio-frequency probe, the same size as the needle done during your diagnostic procedures, that heats up and burns the tiny nerve fibers going to the facet joint. It is just like the diagnostic facet block procedures that were done as tests to prove from where a source of your pain was coming.

You will be positioned in the same manner as your other procedures—on your stomach, and your back will be cleaned. Fluoroscopy (a special X-Ray with a television screen) will be used by the physician, in guiding the needle to the appropriate location. Local anesthetics will be the main analgesia for your procedure, however, you may be given the chose of having an IV placed to receive other medications, which may help you to feel more relaxed during your procedure. Initially, the nerves may be stimulated to verify that those are indeed the nerves to be burned. This may also cause some radiating pain or uncontrollable muscle spasms, which go away quickly. Before the nerve fibers are burned, more local anesthetic is placed into the facet joint area to numb the area--so it is not painful. The burning lasts about 90 seconds per area and more than one area at each level may be done. Depending on the number of levels to be done, your procedure may last 15-45 minutes. You will spend about 30 minutes in the recovery area before going home.

Only one side of your spine will be done at your visit, to allow your body time to adjust to change. It is quite normal for patients to experience and increase in symptoms for 5-7 days after the procedure. This will become apparent after the anesthetic begins to wear off, on the day of surgery, and you may need to take some over-the-counter pain reliever.

Risks of the procedure include bleeding, infection, reaction to any of the medications, or even a decrease of blood pressure with sweats and lightheadedness as a result of anxiety associated with all that is happening around you.

There is a 60% chance of pain relief. This may not be complete pain relief, but it may be enough for you to return to daily living activities. Some people do achieve complete pain relief. With those patients that do not get complete pain relief another facet neurotomy may be possible, because not enough of the tiny nerve fibers were burned during the first procedure. Your physician can determine if this is what you need. A neurotomy typically can last anywhere from three months to 1_ years. It is different for each patient and there are no predictors of outcome success. The nerve eventually grows back and this procedure may be done again—the diagnostic procedures won’t have to be done beforehand.