Facet Rhizotomy

When the spinal facet joint has been determined to be the cause of low back or neck pain symptoms, spinal facet joint or medial branch nerve blocks often provide relief for extended periods. In other patients, these blocks provide useful diagnostic information and short term pain relief but wear off within days or weeks after they are done. When this happens, facet rhizotomy may restore pain relief which lasts for months or years. When a facet rhizotomy is done, a procedural needle is placed onto the medial branch or “facet” nerve using local anesthesia and x-ray guidance. A low voltage electric current is used to gently stimulate the nerve to precisely identify its location. Once the nerve is found, microwave heat energy is applied to the nerve to decrease its ability to carry pain signals. In selected locations in the back and neck, facet rhizotomy has been proven to provide long-term relief of back and neck pain symptoms for up to two years or longer.

What to expect:

Patients will enter the pre-op area where vital signs are taken. For those patients needing sedation an I.V. will be started and medications given. Patients will then enter the procedure room and lie face down on the procedural table with a pillow under the abdomen for lumbar procedures, or face up with a pillow under the head for cervical procedures. An x-ray machine will then be used to localize needle placement to the area where the facet nerve is located. The skin overlying the site of injection is cleaned with antiseptic solution, and covered with sterile drapes. Local anesthesia will be injected to numb the area where the injection will be performed, and a special microwave needle is properly placed. An electric stimulating current is used to confirm the nerve location and produces a mild pressure, aching or tingling sensation in the back, neck, buttocks, or shoulder depending on location. Patients will be asked to inform the physician when they feel these sensations as the stimulating current is applied, and the current may be increased and decreased several times to be sure that the nerve has been properly located. When the nerve localization is complete, the pain specialist will then numb the area and apply microwave energy to the selected nerve branch through the needle to interrupt pain signals. At the completion of the procedure the needle is withdrawn and a bandaid dressing is applied.

Post-procedural followup:

Avoid being on your feet for 2-3 hours following the facet rhizotomy procedure and do not drive or operate dangerous equipment or machinery during this time.
Notify clinic staff if you experience prolonged pain at the injection site, fever, chills, dizziness, or leg or arm numbness that lasts more than 2-3 hours.
A drop or two of blood at the injection site is normal. Contact the office if you experience persistent bleeding or drainage at the injection site and follow all instructions for further care.
Expect to see results from the rhizotomy procedure within 2-5 days. You may experience continued improvement over the next several days, and full benefit may take as long as one month to occur. You may use any supplemental pain medications during this time.
Remember, followup care is essential to determine the success or failure of the procedure, and to plan further care based on the results.
Contact Foothills staff with any additional questions or concerns.