Radiofrequency Neurotomy


What is radiofrequency neurotomy?


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 nerves?


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 procedure?


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 is provided.


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.















Lumbar Radiofrequency



What happens after the procedure?


After the procedure is performed the patient 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.

Post-procedure Instructions


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?

Rest for 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 is present.


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 minutes2-3 times / day.