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What is Spinal Facet Rhizotomy?

Spinal facet rhizotomy is a minimally invasive procedure to destroy nerves that transmit pain impulses from the facet joints of the spine.

What are the Facet Joints?

Facet joints are the joints between the different vertebra of the spine. There are two joints on either side from the neck to the lower back. Arthritis or injury to the facet joints can cause pain. Pain signals from the facet joints are usually transmitted by small nerves called the medial branch nerves. The location of the pain depends on which facet joint is affected. It can affect the neck, shoulder, mid back, chest, ribs, lower back, buttocks, and legs.

Indications for Spinal Facet Rhizotomy

To identify the facet joint as the source of your pain, your doctor will perform a facet joint injection or a medial branch block. This injection contains local anesthetic and steroids and relieves pain when administered in the right location. The pain relief produced is usually temporary though some find it adequate. A spinal facet rhizotomy has a more lasting effect and may be recommended if the facet joint is identified as the source of pain but facet joint injections provide short-lived relief and other conservative measures such as rest, pain medication and physical therapy are inadequate.

Spinal Facet Rhizotomy Procedure

Spinal facet rhizotomy is performed as an outpatient procedure under sedation and local anesthesia. You will lie face down on a table for treatment of lower back pain or on your back if the neck area is being treated. The injection site is cleaned and a local numbing agent is administered.

A thin hollow needle is then inserted to reach the medial branch nerve supplying the facet joint. The doctor guides the needle with the help of fluoroscopic (live-X-ray) imaging. Once the needle position is confirmed, a special needle tip with an electrode is inserted and radiofrequency energy administered for a minute or two to ablate the nerves. The needle is then removed and the site is covered with a dry, sterile bandage. The procedure takes about 15-20 minutes to complete.

What will I Experience Following a Spinal Facet Rhizotomy?

Following the procedure, you will be monitored for a short while and can then return home. You will need someone to drive you home. You may experience pain in the needle insertion site after the procedure. This usually lasts up to a week. It may take up to 6 weeks for a complete benefit, so improvement may not be immediate.

Risks and Complications Associated with Spinal Facet Rhizotomy

With advanced image guidance and interventional techniques, complications are rare. Potential risks include:

  • Infection
  • Allergic reaction
  • Increased pain