Facet rhizotomy uses radiofrequency energy to interrupt the small medial branch nerves that carry pain signals from arthritic facet joints. The procedure is targeted, outpatient, and can provide meaningful relief lasting many months. Candidacy is confirmed by a diagnostic block.
What facet joints have to do with back pain
Each pair of vertebrae meets at two small joints called facet joints, in addition to the disc in front. Like any joint, they can become arthritic with age and produce pain — typically a dull, achy back pain that worsens with extension, twisting, or prolonged standing.Facet-mediated pain is real and treatable. The challenge has been identifying it accurately, because the symptoms overlap with other sources of back pain. A diagnostic medial branch block — temporarily anesthetizing the small nerves carrying signal from the suspected joints — provides the test: if the pain goes away during the block, the joints are the source.
How the rhizotomy works
When the diagnostic block confirms facet-mediated pain, a rhizotomy uses radiofrequency energy to interrupt those same small medial branch nerves more durably. The procedure is performed through small needles placed under image guidance — no incision required. The nerves grow back over months, but during that interval many patients experience meaningful relief.The procedure itself takes well under an hour. Most patients have it under local anesthesia with light sedation and go home the same day.
Where it fits in the bigger picture
Facet rhizotomy is not a cure for arthritis or for back pain generally. It is a targeted intervention for one specific source of pain. For patients whose pain is primarily facet-mediated and who have not responded to conservative care, it can offer many months of meaningful relief — and the procedure can be repeated as the nerves regenerate.For patients whose back pain comes from a different source — a herniation, a stenosis, diffuse degeneration — rhizotomy won’t help, and the diagnostic block tells you that before the rhizotomy is offered.
Send your MRI for a free review
Dr. McMillan reviews each scan personally. You get a candid answer about candidacy before any travel or scheduling.
How a typical patient pathway unfolds
Most patients arrive at Synergy having already seen one or more surgeons elsewhere. The pathway here is built around that reality: a careful second read of the existing imaging, a candid conversation about what is and is not warranted, and — when intervention does make sense — a procedure that is as small as the pathology allows.
The starting point is usually the free MRI review. You upload or mail your existing scan; Dr. McMillan reviews it personally and responds with a candid assessment. If the review suggests you are a candidate for the endoscopic approach, the next step is a $250 consultation (credited toward the procedure if you proceed) to discuss the specifics for your anatomy. If the review suggests you are not a candidate, the response tells you that directly and offers honest guidance about what might serve better.
For patients who decide to move forward, scheduling typically happens within two to three weeks depending on the calendar. The procedure itself is outpatient — most patients arrive in the morning, go home the same day, and are walking with a small dressing covering the incision. Routine follow-up visits over the recovery window are part of the procedure bundle, and the office coordinates with your local providers as needed. Out-of-town patients are accommodated as a routine matter; we see patients from across South Carolina, Georgia, North Carolina, Tennessee, and beyond.
What follows
Most patients return to normal activities within a day or two. Some experience temporary soreness at the needle sites. The therapeutic effect typically develops over the first one to two weeks as inflammation settles. Maximum benefit is usually apparent by a month.Bottom line
Facet rhizotomy uses radiofrequency energy to interrupt the small medial branch nerves that carry pain signals from arthritic facet joints. The procedure is targeted, outpatient, and can provide meaningful relief lasting many months. Candidacy is confirmed by a diagnostic block.
If you’ve been told you need a fusion — or you’re trying to avoid one — a free MRI review is the most useful next step. Dr. McMillan reviews each scan personally and tells you candidly whether the endoscopic approach fits your specific anatomy.
For patients dealing with spinal facet rhizotomy, the conversation comes down to specifics: what your imaging actually shows, what your symptoms are actually telling us, and which procedure (if any) genuinely matches that pattern. The candid answer is sometimes that you do not need surgery yet; the candid answer is sometimes that you do, but a smaller operation than the one you have been quoted. A second-opinion MRI review separates those cases and gives you the information you need to make the decision well.
The Synergy approach to facet rhizotomy
At Synergy Spine Center, facet rhizotomy is performed by Dr. Marion McMillan personally — the same surgeon who reviews your imaging, plans the operation, and handles your post-operative care. This single-surgeon model isn’t unusual for boutique surgical practices; it’s structural at Synergy because the spine literature shows volume-outcome relationships for individual operators. Patients pursuing this procedure most often arrive with a diagnosis of facet joint syndrome or spinal facet arthritis after being told elsewhere that more invasive surgery — typically fusion — is their only path forward.
Candidacy is established before any travel commitment through the free MRI review process. Patients submit recent imaging and a brief clinical history; the review identifies whether the specific pathology shown on imaging would respond to facet rhizotomy or whether a different intervention would be more appropriate. If you’re a candidate, you’ll receive a written assessment along with transparent bundled pricing for the procedure. If you’re not a candidate, you’ll be told that directly, often with a referral to the appropriate specialty — the review is screening, not sales.
Recovery from facet rhizotomy is intentionally faster than from traditional open spine surgery or fusion. Most patients return to office work within one to two weeks; manual labor takes four to six weeks. Routine post-operative follow-up is included in the bundled price, and for out-of-town patients much of the follow-up happens remotely through phone or secure video — the 3-day plan documents typical visit cadence. Authoritative clinical background on this procedure is also available at Cleveland Clinic — Rhizotomy for patients who want to read more about the underlying evidence.
Frequently asked
How long does the relief last?
Many patients experience meaningful relief for several months to a year or more. The small nerves do regenerate, and the procedure can be repeated when symptoms return. To find out whether you’re a candidate for facet rhizotomy, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides candid candidacy assessment within several business days.
Is the diagnostic block necessary?
It’s strongly recommended. The block confirms that the facet joints are actually the source of the pain — which is the prerequisite for the rhizotomy doing anything useful. To find out whether you’re a candidate for facet rhizotomy, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides candid candidacy assessment within several business days.
Is it painful?
The procedure is performed with local anesthesia and typically light sedation. Most patients describe pressure but not sharp pain during the rhizotomy itself. For background on the most common diagnosis treated with this procedure, see the facet joint syndrome page, which covers symptoms, diagnostic workup, and treatment options in detail.
Will my insurance cover it?
Most major insurers cover facet rhizotomy in appropriately selected patients with a positive diagnostic block. The office can confirm coverage specifics. To find out whether you’re a candidate for facet rhizotomy, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides candid candidacy assessment within several business days.
Are there risks?
Risks are low but include bleeding, infection at the needle sites, and temporary numbness in a small skin patch. The radiofrequency does not damage joints or significant nerves; it targets only the small medial branches that carry pain signal. Transparent bundled pricing for facet rhizotomy is published openly at /spine-surgery-cost-transparent-pricing/, so you can plan financially before scheduling and avoid surprise bills.
Can I have it repeated?
Yes. The nerves regenerate over months; when symptoms return, the procedure can be performed again. For background on the most common diagnosis treated with this procedure, see the facet joint syndrome page, which covers symptoms, diagnostic workup, and treatment options in detail.
How this page was prepared
This page summarizes the clinical approach taken at Synergy Spine Center for the topic above. It is based on peer-reviewed literature, professional society guidelines (NASS, AAOS), federal patient education resources (NIH, AHRQ, CMS), and Dr. McMillan’s experience as Director of Spinal Medicine and Endoscopic Spinal Surgery. Outcome language is qualified. Individual results vary. Pricing where shown is current for 2026 and may change.
References
- OrthoInfo — facet joint pain and treatment. — source
- NASS — radiofrequency neurotomy resources. — source
- PubMed — clinical literature on facet rhizotomy. — source
- Cleveland Clinic — Rhizotomy — clinical reference relevant to facet rhizotomy.
- PubMed — Facet Rhizotomy — clinical reference relevant to facet rhizotomy.
Synergy Spine Center publishes patient education content for general information only; it is not medical advice and does not establish a physician-patient relationship. For specific medical guidance, schedule a consultation. No identifiable patient information is included on this page.