A radiofrequency neurotomy is use of radiofrequency energy mediated heat to ablate the nerve responsible for facet joint pain or sacroiliac joint pain caused by arthritis or other degenerative changes, or from an injury.
Ablation if the nerve beaks the pain signals to the brain, thus eliminating pain.
The term radiofrequency ablation is also used for this procedure.
There are two primary types of radiofrequency neurotomies –
- A medial branch neurotomy for the nerves carrying pain from the facet joints
- A lateral branch neurotomy for nerves that carry pain from the sacroiliac joints.
Both of these brancheeshave no motor control in arms or legs. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.
The facet joints or zygapophysea joints are the sources of chronic low back pain in in 15% to 45% patients. This sensation is carried by medial branch of posterior primary ramus. A block of this nerve would determine the nerve to be cause if there is significant decrease in pain (>50%
Similarly, a sacroiliac would determine whether lateral branch is involved.
Procedure of Radiofrequency Neurotomy
- With iv line in place, the patient is positioned prone on the operative table.
- The skin over the neck, mid-back, or low back is well cleaned.
- The desired area over the skin is numbed with local anesthetic.
- Radiofrequency needle is inserted alongside the medial or lateral branch nerves.
- After confirmation of correct placement, nerve stimulation was done by passing small amount of electrical current to assure it is next to the target nerve and a safe distance from other nerves.
- The current causes a muscle twitch or pain sensation
- Local anesthetic is injected on to the nerves so that pain of the procedure is not felt.
- Introduction of radiofrequency waves heat the tip of the needle and lesion the nerve.
The procedure is a day care procedure and the patient can be sent home same day.
The patients are advised to avoid driving and avoid doing any strenuous activities on the same day. The area treated could be sore fore few day and patient might require analgesics.
Some patients may complain of a superficial burning pain/numbness with hypersensitivity lasting for 1 – 2 weeks
Full pain relief will typically occur within 2 to 3 weeks after the procedure.
Some patients may have recurrence of the pain after a period of pain relief as the nerve regrows back.
In these cases, a second radiofrequency neurotomy can be performed
Prognosis of Radiofrequency Neurotomy
About 30% to 50% of patients undergoing will experience significant pain relief for as long as two years. Out of the rest, another 50% will get some pain relief for a shorter period.
Some patients do not experience any relief.
Success rates are greater in the cervical spine (neck) than in other areas.
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