Radiofrequency Neurotomy of Medial Branches
The anatomy of the facet joint
The facet joints are situated in the back and neck. They are paired joints which are found at every vertebral level. Facet joints are surrounded by synovial fluid and have surfaces of cartilage, which serve the purpose of reducing friction from rubbing bones.
The medial branch nerve carries pain signals from the facet joints. Targeted lesioning of these nerves disrupts pain signals for a period of 12 – 24 months. Radiofrequency neurotomy is a type of injection which is used to address facet joint pain. The location targeted by the facet joint radiofrequency neurotomy will depend on the type of facet joint: cervical facet joints are found on the side or back of the neck; thoracic facet joints are in the upper back; and lumbar facet joints are in the lower back.
Radiofrequency Neurotomy of the nerves supplying the facet joint will be performed when there is demonstrable benefit from diagnostic Medial Branch blocks or facet joint injections.
Causes of facet joint pain
Facet joint pain can have a number of causes, including pressure overload of the joints, injury or wear and tear(aging). The joint could become strained an activity which an individual undertakes regularly, such as forms of physical exercise or manual work. It may also be consequence of a whiplash accident.
Disc degeneration can be a typical precursor to the pressure overload on the facet joints, as it causes the narrowing of the space between each vertebra, which in turn leads to a build-up of pressure on the articular cartilage surface.
Facet joint arthritis has the ability to destroy the cartilage and fluid which is used for lubrication of the joints, causing pain.
Radiofrequency Neurotomy procedure
Facet joint Radiofrequency Neurotomy involves the creation of a heat lesion on medial branch nerves in order to interrupt signals to the brain. This can have the effect of eliminating the facet joint pain for 12-24 months.
The most typical forms of facet joint radiofrequency neurotomy is a medial branch neurotomy which targets the nerves that carry pain signals from the facet joints.
It is performed using fluoroscopy (live X-ray) to help guide the needle accurately and avoid any nerve injury. The procedure will take place in theatre under full aseptic conditions with the patient on his or her stomach (or on the side for the neck). A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. For the injection itself, the physician would use fluoroscopy in order to guide the radiofrequency needle as accurately as possible to the medial branch nerves and performs precision and safety tests. The physician then directs a radiofrequency needle to the medial branch nerves and performs precision and safety tests. After this, the targeted nerves are numbed, a heat lesion is created by radiofrequency waves on the tip of the needle, allowing the lesion to disrupt pain signals. A small mixture of steroid (anti-inflammatory medication) and anaesthetic is then injected.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for seven or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
Depending on the number of levels, the procedure typically takes around an hour, and patients are normally allowed to return home on the same day.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved with Radiofrequency neurotomy including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Side effects can include a new burning sensation or numbness. Paralysis, spinal cord or nerve damage is extremely rare.