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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.
What causes the cervical facet joints to become painful?
Osteoarthritis 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.
In addition, rheumatoid arthritis, ankylosing spondylitis, spinal stenosis,
injury, poor posture, and wear and tear may also contribute to a painful facet
joint disorder.
How can PRFN relieve symptoms?
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.
What are the possible complications with PRFN?
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 conclusive: bleeding, infection, nerve or spinal cord
injury, increased pain, allergic or other reaction to medications used (e.g.
anesthetic).
Is the pain relief permanent?
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 performed?
Medicine to relax the patient is administered through an IV (intravenous line)
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 patients expect?
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 (e.g. anti-inflammatory).
In general, patients can expect a significant reduction of their pre-procedural
pain in one to four weeks.
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