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RADIOFREQUENCY NEUROTOMY OF FACET JOINT NERVES
     

Q: WHAT IS IT?

A: A radiofrequency current is a type of electric current.  When it is applied to facet joint nerves, which are also called the medial branch nerves, it can block those nerves for a long time, lasting anywhere from a few months to a few years.  (If you are looking on the internet, you may also see this procedure called a “facet neurotomy”, “medial branch neurotomy” or “medial branch rhizotomy”.)

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Q: AM I A GOOD CANDIDATE FOR THIS PROCEDURE?

A: You are a good candidate for this procedure if you have obtained relief of your usual pain when diagnostic blocks were performed on the involved nerves.  Note that some people have pain in several areas, the diagnostic block doesn’t need to block all of the different pain locations in your body, but it does need to relieve pain in the area targeted by the diagnostic procedure.

Q: WHAT ARE THE BENEFITS OF RADIOFREQUENCY NEUROTOMY?

A: It disrupts nerve conduction from the involved facet joint/s and most likely will reduce pain and other related symptoms.  Approximately 70-80% of patients will get good results.  Sometimes after the nerves are blocked it becomes clear that some of your pain is relieved but there is still pain from other areas as well.

Q: HOW LONG DOES IT TAKE?

A: Depending on the areas to be treated, the procedure can take from about thirty minutes to a couple of hours.

Q: HOW IS IT ACTUALLY PERFORMED?

A: It is done in the operating room or procedure room, the same as when you had the diagnostic facet joint nerve blocks.  Intravenous medication can be provided if necessary during the procedure.  The skin is anesthetized with a local anesthetic and the radiofrequency needles are carefully advanced with x-ray guidance until positioned next to the involved facet joint nerves.  We then apply a mild electrical current to the facet joint nerves to confirm that the needles are properly positioned; you might feel this current as pain or tingling in your usual painful areas.  Next a radiofrequency current is applied to each of the nerves we need to block.

Q: WILL IT HURT?

A: Sometimes it can be uncomfortable when we place the radiofrequency needles.  We use local anesthesia and intravenous medications to keep you as comfortable as possible.

Q: WILL I BE ASLEEP FOR THIS PROCEDURE?

A: It is not safe to be completely unaware during the procedure.  You also need to be awake enough to communicate with us during the part of the procedure where we stimulate the nerves to be sure of accurate needle placement.

Q: WHAT SHOULD I EXPECT AFTER THE PROCEDURE?

A: Pain relief can begin within days, but sometimes it takes up to two or three weeks to notice maximal improvement.  There is usually some soreness from the procedure for a few days, sometimes up to one week afterward.  Ice packs and pain medication are sometimes needed.

Q: WHAT SHOULD I DO AFTER THE PROCEDURE?

A: You should have a ride home and take it easy for the rest of the day.  You can usually resume your usual activities the next day.

Q: HOW LONG DOES THE EFFECT OF THE PROCEDURE LAST?

A: It can last from three months to almost two years.  Many patients with whiplash injury will have permanent relief.

Q: HOW MANY PROCEDURES DO I NEED TO HAVE?

A: Usually one will relieve most or all of your pain.  If it blocks some areas of your pain but not all, then we will want you to come in for an office visit and re-evaluation.  Sometimes at that visit we find that we need to repeat the procedure, other times we find that it is likely to be a different structure causing your remaining pain and then a different procedure is likely to be helpful for you.  If you had a successful procedure and your pain returns after a while then we can safely repeat the procedure at that time.

Q: WILL IT HELP ME?

A: 70-80 % of patients will get relief of anywhere from about two-thirds of their pain to complete relief.  But 20-30 % of patients will not obtain relief from this procedure.

Q: WHAT ARE THE RISKS?

A: It is common to have some soreness afterward.  There is a very rare risk of infection, as with any procedure.  There is about a 20-30% chance that it will not help you.  The needle is carefully positioned and its position is double-checked with electrical stimulation of the nerves targeted, but there is a very rare chance that other nerves near the target could be damaged.

Q: WHO SHOULD NOT HAVE THIS PROCEDURE?

A: You should not have it unless you have obtained pain relief from the diagnostic facet nerve blocks.  If you are on Coumadin, Plavix or Ticlid then you will need to stop taking them as per our instructions in advance of the procedure.  If you have an infection then you should have that infection treated prior to the procedure.

Q: WHAT CAN I DO TO IMPROVE MY CHANCES FOR SUCCESS?

A: You can do a lot to help yourself.  Working up to being physically fit as you can be.  Build up to a good level of fitness that includes aerobic exercise, strengthening and stretching.  Weight control is also very important to reduce pressure on the facet joints.  Please let us know what we can do to help you succeed.

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