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Facet Rhizotomy Procedure: What to Expect

Peer Reviewed

A facet rhizotomy may help to relieve pain by "turning off" the pain signals the spine's facet joint(s) send to the brain. To help you prepare for the 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.

About the Procedure
The procedure begins with a mild sedative administered intravenously (by IV) to keep you comfortable but awake during the procedure. A local anesthetic is injected to numb the procedure site.

Your pain physician utilizes fluoroscopy (real time x-ray) to guide placement of the needle (electrode). Once the needle is in place, a mild electrical current stimulates the nerve and confirms 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
You may experience some discomfort  immediately after the procedure, such as bruising, soreness, or swelling at the injection site. Most patients are able to return to work and/or their normal daily activities the day following a facet rhizotomy.

Your back may be sore for a few days after the procedure. Usually cold therapy (eg, ice pack) and/or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) help ease post-procedure symptoms. Soon, you should begin to notice an improvement in your usual pain. Improvement usually continues during the next several weeks.

Serious Complications are Rare
As part of your post-procedure instructions for recovery at home, your physician provides additional contact information should you experience any of the symptoms listed below. Should you experience any one of these symptoms, quickly contact your physician.

  • 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
Updated on: 11/17/14
Michael J. DePalma, MD
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.
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