Facet Neurotomy

What is it?
Facet neurotomy is a procedure which results in interruption of the nerve supply to a facet joint. This interruption known as denervation, is accomplished by a radio-frequency probe that heats the 2 small nerve branches to each facet joint. These nerves are called the medial branches.

How is it done?
With the patient in a prone position and under local anesthesia and fluoroscopic guidance, a radio-frequency needle is advanced to the base of the transverse processes. The needle is placed along the course of the medial branch. The needle is heated to 80° C for 90 seconds. At least 2 branches for each joint are treated in this same manner.

How long does it take?
The neurotomy takes 10 to 45 minutes, depending on the number of levels to be done. The patient is then recovered in the observation area for 30 minutes to 1 hour.

Potential Risk
Increased localized back pain and/or leg pain can be expected from several days to several weeks and rarely several months. Destabilization of the facet joint is a risk and post injection training to strengthen the extensor muscles can prevent this possibility.

Expected Outcome
Following the neurotomy, there is a 60% chance of pain relief. This typically last for 3 months to 1 1/2 years. The nerve eventually grows back and the procedure can be repeated. While the patient is experiencing pain relief, vigorous physical therapy is necessary to try and strengthen the involved facet joint(s).

Glossary:

Neurotomy - Division, transection or dissection of a nerve.
Discogram
SNRB
Epidural
Facet
Sympathetic
Costovertebral
Stellate Ganglion
Neurotomy