Facet Rhizotomy

	Steven Richeimer, MD Chief, Division of Pain Medicine Keck School of Medicine, University of Southern California Los Angeles, CA, USA
	Ms. Mary Claire Walsh SpineUniverse Staff Writer

The facet joints are often the primary source of pain for many back pain sufferers. Facet joints are small joints located in pairs on the back of the spine that provide stability to the spine and allow the spine to move and be flexible.

facets

Depending on where the problematic facet joints are located, they can cause pain in the mid-back, ribs, chest (thoracic facet joints), lower back, abdomen, buttocks, groin, or legs (lumbar facet joints), neck, shoulders, and even headaches (cervical facet joints).

Facet joint injections of steroid medications are often given to patients with this type of pain. The injections not only provide pain relief, they can also help the physician pinpoint exactly where the pain originates and can confirm or reject the facet joints as the source of the pain. For many patients, facet joint injections provide adequate relief. For others, however, the pain relief is too short-lived. For these patients, facet rhizotomy may be the answer.

What is facet rhizotomy?
The goal of a facet rhizotomy is to provide pain relief by "shutting off" the pain signals that the joints send to the brain. The pain relief experienced by most patients who have this procedure lasts months or even years.

How it is done
Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed along side the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

Serious complications with facet rhizotomies are rare. A new technique using pulsed radiofrequency does not actually burn the nerve, but appears to stun the nerve. This technique appears to be even safer than the regular radiofrequency technique, but does seem to have the drawback of not lasting quite as long. Some specialists (such as the author) prefer to use the pulsed technique in higher risk areas such as the neck.

The procedure takes about 30-60 minutes. Afterwards, patients are monitored for a short time before being released.

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Article written 09/01/2004
Published online 09/09/2004
Last updated 05/16/2006

Facet joint rhizotomy or medial branch neurotomy can effectively treat low back pain emanating from painful facet joints unresponsive to steroid injections. This efficacy hinges on the technical skill of the physician performing the procedure. Each facet joint is supplied by two small nerves so two needles must be placed to treat one joint. Findings of a recent surgical anatomical study have confirmed the accurate course of these nerves targeted in this procedure providing more compelling evidence for proper needle placement. Safe needle placement is critical in avoiding complications related to inadvertent injury to nearby structures leading to increased back or new leg pain. Although symptom reduction may be appreciated within a few days, facet joint rhizotomy should not be considered unsuccessful unless no pain relief occurs by 6 weeks after the procedure. Evidence shows that 60% of properly selected patients experience at least a 90% reduction of their low back pain that is sustained for 12 months, and 87% obtain at least 60% relief. If low back pain symptoms return over time, repeating the procedure can restore similar pain relief. However, one must keep in mind that these results are attainable when completed by well-trained interventional spine specialists experienced in executing these procedures.

Michael J. DePalma, MD

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