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.
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, but 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 (also called radiofrequency rhizotomy) may be the answer.
What Is Facet Rhizotomy?
The goal of a facet rhizotomy, either a cervical facet rhizotomy or lumbar 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 Facet Rhizotomy 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 alongside 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.