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Facet Joint & Medial Branch Rhizotomy

Helping Residents of North Central Arkansas and South Central Missouri Relieve Pain

Joints located on the outside of the spinal column are called facet joints. These joints are what allow us to have full mobility of the spine. Without these synovial joints, our spinal movements would be extremely limited and stiff. Unfortunately, facet joints can become damaged or inflamed by whiplash injuries, spinal arthritis, spinal degeneration, and spinal surgery. These joints can be found in the neck area, lower back area and mid-back area. Facet joints are interconnected by a set of nerves called medial branch nerves. These nerves are responsible for transmitting pain signals from the facet joints to the central nervous system. Even with the use of physical exams, CT scans, and MRIs, it is impossible to locate the exact source of pain in the facet joints. Oftentimes, a diagnostic nerve block is necessary to limit or eliminate the pain. After you have undergone two diagnostic medial branch nerve blocks, we will consider you for a medial branch rhizotomy. This procedure will involve the usage of a specialized needle to deliver radiofrequency heat to the medial branch nerve. This, in turn, will destroy the nerve, thereby reducing your back pain significantly.

Several medical conditions that are commonly treated using medial branch rhizotomies are:

  • Scoliosis: Abnormally curved spine
  • Lumbago: Pain in the lower back
  • Failed back surgery syndrome: pain in the back even after a spinal surgery
  • Cervicalgia: Pain in the neck area
  • Spondylosis: facet joints degenerated by osteoarthritis

For more information regarding this procedure, please call Interventional Pain Management, a department of Baxter Regional, at (870) 508-5900.

The Procedure

On the day of your scheduled procedure, please arrive at least 20 minute prior to the start time. Our highly trained nurses will begin an IV if you want to be sedated, and then they will conduct a nurse pre-operation assessment. After, you will be taken to a hospital bed in the procedure room and given nitrous oxide and sedation to make you more comfortable. We place cold cleaning solutions on our patients, at this point, to lessen the chance of infection. Using x-ray guidance, our doctor will identify the procedure site and place a small needle into the site of the medial branch nerve. There are usually a total of four needles placed on each side. Using contrast dye, we will confirm the proper placement of the needle and the needle is then tested for motor and sensory function. The sensory test may be slightly uncomfortable in the area in which you are experiencing pain. However, do not worry as this is normal and actually confirms that the needle placement was correct. We then conduct motor testing in which you may experience some muscle twitching and slight limb spasms. Once we confirm the needle placement is correct, and the motor and sensory testing is acceptable, we will inject local anesthetic. Finally, we will heat the needle tip with a specialized machine up to 90 degrees Celsius for 1 minute at each level. Afterwards, we remove the needles and repeat the procedure on the same side.

What to Expect After the Procedure

Medial branch rhizotomies may lead to increased pain level just for a couple days after the procedure. This kind of pain is usually described as a sunburn-type, numbing, or slightly burning, pain. This is completely normal and is expected due to the destruction of the nerve. We highly recommend icing the affected area and taking anti-inflammatory medicine like Aleve, Advil, and ibuprofen to reduce the pain and inflammation. Many patients report not feeling the full effects of the rhizotomy procedure until three to four weeks after the procedure. The pain relief induced by this procedure may last anywhere from six months to two years. Unfortunately, the nerve will eventually grow back and that may lead to a return of previous pain levels. The procedure can be repeated every six to eight months, if necessary.

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