Spinal Facet Rhizotomy

Endoscopic spinal surgery approaches

Debilitating pain narrows your world. Decreased range of motion only works to make your body less apt to perform. Facet rhizotomy changes that. Pain is significantly lessened or eliminated all together.

Diagnostic facet injections or “blocks” are not only used to confirm the facet joint as the cause of spinal pain symptoms. When the spinal facet joint has been determined to be the reason of low back or neck pain symptoms, facet rhizotomy may also provide long term pain relief which can last for months or years. Repeated spinal injections and supplemental pain medications may be unnecessary. The procedure may be performed traditionally with needles or, more recently, under direct endoscopic vision.

The facet nerve is located by a low voltage electric current or by direct endoscopic visualization. Once the nerve is found, microwave heat or laser heat energy is applied to intentionally damage the nerve to decrease its ability to carry pain signals. In selected locations in the back and neck, facet rhizotomy may provide long-term relief of back and neck pain symptoms for years or permanently.

Rhizotomy is frequently performed in association with spinal stenosis surgery, as the facet joint is nearly always arthritic in stenosis patients. Rhizotomy is also known as neurotomy, or facet nerve ablation. The techniques are all similar.

What to Expect

  • Patients will enter the pre-op area where vital signs are taken.
  • For those patients needing sedation an IV will be started and medication 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 nerve location is confirmed.
  • The patient will be asked to inform the physician when they feel these nerve pressure sensations as a stimulating current is applied.
  • 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 physician will then numb the area and apply microwave or laser energy to the selected nerve branch through the needle or endoscope to interrupt pain signals.
  • At the completion of the procedure, the surgical instruments are withdrawn and a Band-aid dressing is applied.

Post-Procedural Follow-up

  • Avoid being on your feet for 2-3 hours following the facet joint injection.
  • 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 injection with 2-5 days. You may experience continued improvement over the next several days, and full benefit may take as long as two weeks to occur. You may use any supplemental pain medications during this time.
  • Remember, follow up care is essential to determine the success or failure of the procedure, and to plan further care based on the results.
  • Contact Synergy Spine Center staff with any additional questions or concerns.

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