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Radiofrequency Lesioning

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 communication of pain between a specific medial nerve root and the brain.  The medial nerve roots supply the spine's facet joints.

Before a 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, it is not harmful to disrupt or turn off their ability to send pain signals to the brain.

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.

Each facet joint is innervated by a medial branch nerve.  The medial branch nerves control sensation to the facet joint.  When there is degeneration or inflammation within 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

In advance of your procedure appointment, instructions are provided specific to you and medications you regularly take. 

If you take blood thinning medication, such as Coumadin, Plavix, aspirin, etcetera, please notify the medical staff. Certain drugs must be stopped several days before your procedure.

Possible Risks and Complications

A radiofrequency rhizotomy (lesioning), like other medical procedures, 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. 

In the operating room, you are comfortably positioned and a cushion is placed either 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 a 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.  As the electrode is heated, the medial branch nerve is cauterized (burnt). 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 2); the procedure takes 15 to 20 minutes.  Afterward, in the recovery area, you are closely monitored by the medical staff.  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 keep in mind where pain and symptoms are in relationship to the injection site.  The pain diary will help you provide your doctor with detailed information about your treatment progress when return for your follow-up office visit.