Radiofrequency neurotomy is a procedure which
results in the interruption of the nerve supply to a facet joint
or sympathetic chain. This interruption known as denervation is
accomplished by a radiofrequency probe that heats the two small
nerve branches supplying the facet joint known as medial branches
or sympathetic ganglion.
What are facet joints?
Facet joints are the joints
between vertebra, present on both sides of the spine, number two
for each disc, provide flexibility to the spine which allows you
to bend at waist.
Each vertebra has two sets of facet joints. Once
pair faces upward (superior articular facet) and one downward (inferior
articular facet). There is one joint on each side (right and left),
facet joints are hinge-like and link vertebra together. They are
located in the back of the spine which is called posterior aspect.
Facet joints are synovial joints. This means
each joint is surrounded by a capsule of connective tissue and
produces a fluid to nourish and lubricate the joint. The joint
surfaces are coated with cartilage allowing joints to move or glide
smoothly against each other.
What are the sympathetic
The sympathetic nerves run on the front surface
of the spinal column (not in the spinal canal with the nerves from
the central nervous system). The sympathetic nerves are part of
the autonomic nervous systems which basically controls functions. In
other words, the autonomic nervous system is responsible for controlling
things people do not have to think about or have direct control
concerning their function. However, there is a connection between
the central and autonomic nervous systems. Sometimes arm and leg
pain is caused by a malfunction of the autonomic system secondary
to an injury.
What happens during the
To perform this procedure
initially a patient should have had local anesthetic injections
on at least two occasions. If it provides very good relief but
it was short lived then this procedure may be offered.
The patient is taken into
the holding area and intravenous infusions started and sedation
Following this the patient
is taken into the operating room and positioned on the stomach
for all the regions.
Appropriate preparation is carried out by sterile
scrub. Following this the physician numbs a small area of skin
with the medicine. After the numbing medicine has been given time
to be effective, the physician directs a small special needle,
using x-ray guidance positioning it over the medial branch or sympathetic
nerve. Following this appropriate stimulation of the nerve is
carried out. Following this a local anesthetic is injected. After
that the needle is heated 50°-60° for 90 to 120 seconds.
At least two branches for each joint are treated
in the same manner for both sympathetic nerves and facet joint
pain. Also, two or three needles are used for sympathetic neurotomy
however, local anesthetic is not injected.
What happens after the procedure?
After the procedure is performed thepatient is closely monitored
for any complications or side effects in the recovery room for
approximately 20-30 minutes.
Occasionally following this procedure there may be increased
pain at the site of the needle placement or in the leg or upper
extremity which may last for several days on rare occasions.
You were given a number of medications during the procedure. These
sometimes include sedatives, narcotics, local anesthetics, steroids,
and other medications. Any of these drugs or procedure itself,
sometimes can cause side effects, including drowsiness, temporary
numbness, weakness and soreness.
What To Do After the Procedure?
a few hours and use assistance if needed.
Resume activity as tolerated, but do not overdo.
Resume regular diet.
Do not drive or operate
machinery for at least 12 hours.
Do not make important decisions for 12-24 hours after treatment.
Walk with assistance as long as numbness, weakness, or drowsiness
Notify If You Have:
Excessive or abnormal
bleeding / persistent chills or fever over 100°F.
If there is a major change in pain pattern or level.
In case of emergency, call (270) 554-8373.
If unable to reach physician report to the nearest emergency room
and request them to inform physician at Pain Management Center.
Few Other Things:
Take your usual medication.
Apply ice massage as instructed; may use heat if ice is intolerable.
If IV site becomes painful, place warm towels on the site for 20
2-3 times / day.