Rhizotomy

A rhizotomy is a minimally invasive surgical procedure used to treat neck and back pain resulting from arthritis of the facet joints of your spine. Your doctor performs a rhizotomy only after confirming that the facet joint is the cause of your pain. Refer to the top left illustration.

You may be a candidate for a rhizotomy if more conservative pain remedies have not been effective and no other facet joint treatments are appropriate. This is a temporary procedure that provides pain relief for up to about six months.

OVERVIEW

This minimally invasive procedure, also called radiofrequency (RF) rhizotomy, reduces or eliminates the pain of damaged facet joints. It works by disrupting the medial branch nerves carrying the pain signals. You are given a local anesthetic for this outpatient procedure. The technique is detailed below. Discuss your risks and post-operative expectations with your doctor.

1. INSERTING THE CANNULA

Your Southeastern Spine Institute (SSI) physician positions a needle-like tube called a cannula near your irritated medial branch nerves. He or she uses a fluoroscope, which displays live X-ray images, to guide the insertion of the cannula to the nerves. See illustration 1.

2. INSERTING THE ELECTRODE

The doctor inserts a radiofrequency electrode through the cannula, as shown in illustration 2. He or she tests the electrode’s position with a weak electric jolt. If the stimulation recreates the pain without any other muscular effects, your doctor has positioned the electrode correctly.

3. TREATING THE NERVE

The physician uses the electrode to heat the nerve and cauterize it. The heat disrupts the nerve’s ability to communicate with the brain, essentially blocking the pain signals. Your doctor may treat multiple nerves if needed.

4. RECOVERING FROM THE PROCEDURE

After the procedure, the doctor removes the electrode and cannula. He or she covers the injection site on your skin with a small bandage. Although your pain may increase during the first post-operative week, you should have full relief from pain within a month.

The procedure takes about 30 minutes to complete. You can return home after this same-day surgery, but you need to rest for at least three days. A successful radiofrequency rhizotomy can provide pain relief much longer than steroid block injections.