Cervical Facet Joint Pain Treatment
Pulsed Radiofrequency Neurotomy (PRFN) Provides Many Patients Relief
Is there anything worse than neck pain? If you ask someone who suffers with chronic neck pain, the chances are their reply is a resounding "No!" Neck pain often radiates into the shoulders and upper back and may be accompanied by other symptoms such as headaches and extremity tingling and numbness.
Chronic neck pain sufferers may wonder, "What causes neck pain and how can this aggravating pain be stopped?" One cause is dysfunction or disease affecting the cervical facet joints. The cause, combined with a treatment called Pulsed Radiofrequency Neurotomy (PRFN) (or Pulsed Radiofrequency Rhizotomy), is the topic of this article.
What Is a Cervical Facet Joint?
Facets are the spine's system of joints that enable movement. Another term for the facet joints are zygapophyseal or apophyseal joints.
At the back of each vertebra are two sets of facet joints. One pair faces upward and one downward; with one joint on the left and right sides of each vertebra. Facet joints allow flexion (bend forward), extension (bend backward), and twisting motion. In general, the spine is made more stable due to the interlocking nature of the facet joints to the adjacent vertebrae.
Similar to other joints in the body, each facet joint is surrounded by a capsule of connective tissue and produces fluid to nourish and lubricate the joint (synovial fluid). The joint surfaces are coated with a thick spongy material termed articular cartilage that enables the bones of each joint to smoothly move against the other.
Osteoarthritis (spondylosis) is probably the most common cause of cervical facet joint pain. This degenerative disease causes progressive cartilage deterioration. Without the spongy cartilaginous cushion, joint bones begin to rub against each other when at rest and during movement.
Another condition, degenerative disc disease (DDD), may compromise the structural integrity of the intervertebral discs causing discs to lose normal height. Loss of disc height may cause the affected facet joints to become positioned too closely thereby disrupting the joint's ability to function normally.
Pulsed Radiofrequency Neurotomy (PRFN) is a minimally invasive procedure that disables and prevents a specific spinal nerve from transmitting pain signals. PRFN is a modified version of a procedure termed Radiofrequency Therapy (RT), a procedure developed more than 30 years ago. PRFN is still fairly new, but more and more pain management specialists are performing this procedure to treat painful facet joints.
Like its predecessor, PRFN applies a precisely targeted electrical field to change the function of nerves,in this case, a specific branch of a spinal nerve rendering it incapable of transmitting pain signals. However, PRFN is different! A primary difference between the original technique (RT) and PRFN is that 'pulsed' radiofrequency applies an electrical field to the target nerve for short intervals at a lower temperature, which does not destroy nerve tissue, but rather "stuns" the nerve.
As with any medical procedure, there are risks and potential complications. Although complications rarely occur, patients need to know what could happen. The following list is not inclusive:
- nerve or spinal cord injury
- increased pain
- allergic or other reaction to medications used (eg, anesthetic).
Will PRFN Permanently Relieve Your Neck Pain?
For many patients who suffer chronic neck pain, PRFN is an effective treatment that may provide relief for months or longer. Even when normal function returns to the target, pain relief may continue. If the patient responded well to the first PRFN, a second may be considered if pain resumes.
Of course, each patient is unique and it must be remembered that what works well for one person, may not work well or at all for another.
How Is the Procedure Done?
Medicine to relax the patient is administered through an IV and the patient is positioned on a padded x-ray table. The skin over the injection site is thoroughly cleaned and then numbed using an anesthetic.
The entire PRFN is performed using fluoroscopic guidance. Fluoroscopy is similar to a real-time x-ray and allows the physician to see the patient's anatomy while guiding and positioning a special needle (pulsed radiofrequency electrode) into place.
Using gentle electric pulses through the needle, the physician can cause muscle twitches or tingling sensations that confirm that the needle is properly and precisely positioned next to the targeted spinal nerve branch. Electric energy is then applied for the next 2 to 4 minutes to "stun" the nerve. Unlike the more traditional radiofrequency "burn", the pulsed technique is so gentle that it does not even require that the target nerve be numbed. This procedure is repeated for each targeted nerve root. In general, there is minimal pain with this procedure. Patients may feel a mild pulsating feeling in the area during the "stunning."
What Should You Expect After Treatment?
Like other minimally invasive outpatient procedures, some post-procedural pain or discomfort should be expected. Usually an over-the-counter NSAID is sufficient to relieve this discomfort. In some cases, post-procedural pain may increase and the physician will prescribe needed medication (eg, anti-inflammatory).
In general, patients can expect a significant reduction of their pre-procedural pain in one to four weeks.