Facet Rhizotomy: Procedure Preparation and Aftercare

	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

What to expect
Very little preparation is required for a facet rhizotomy procedure:

•Your physician will give you detailed instructions about whether you can eat before the procedure.
•In most cases, you can continue to take your usual medications before a rhizotomy. However, make sure you discuss what medications you use with your physician before the procedure.

•Since a rhizotomy requires the use of a local anesthetic, you may need someone to drive you home after the procedure.

Once you are ready, you will be given an IV with a mild sedative to keep you comfortable but awake during the procedure. A local anesthetic will be used to numb the area where the injection is to be done. An x-ray machine is then used to guide the exact placement of the needle/electrode. Once the needle is injected, a mild electrical current is used to stimulate the nerve and confirm its exact location. You may feel slight pressure or tingling during this part of the procedure. Then the electrode is heated to deaden the sensory nerves. When the procedure is completed, the needle is removed and the injection site is bandaged.

After the procedure
Some initial discomfort may be experienced immediately after the procedure, including bruising, soreness, or swelling at the injection site. However, most patients are able to return to work and their normal daily activities the following day.

Also, your back may be sore for a few days after the procedure. This is procedure-related pain and can be treated successfully using ice packs or over-the-counter pain medications. After a few days, you should begin to notice an improvement in your usual pain and can expect continued improvement over the next several weeks.

Serious complications are rare, however contact your physician if you experience any of the following:

•Prolonged pain at the injection site
• Fever
• Chills
• Dizziness
• Weakness
• Numbness that lasts more than 2-3 hours
• Bleeding or drainage at the injection site

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Article written 09/01/2004
Published online 09/09/2004
Last updated 11/21/2005

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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