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Spinal facet rhizotomy:
Diagnostic facet injections or “blocks” are used to confirm the facet joint as the cause of spinal pain symptoms. When the spinal facet joint has been determined to be the cause of low back or neck pain symptoms, facet rhizotomy may provide long term pain relief which can last for months or years, such that repeated spinal injections and supplemental pain medications are unnecessary. Facet rhizotomy may be performed traditionally with needles or more recently under direct endoscopic vision. The facet nerve is located by a low voltage electric current or by direct endoscopic visualization. Once the nerve is found, microwave heating or laser heat energy is applied to intentionally damage the nerve and decrease its ability to carry pain signals. In selected locations in the back and neck, facet rhizotomy may provide long-term relief of back and neck pain symptoms for years or permanently. Rhizotomy is frequently performed in association with spinal stenosis surgery, as the facet joint is nearly always arthritic in stenosis patients. Rhizotomy is also known as “neurotomy”, or “facet nerve ablation”. The techniques are all similar.
What to expect:
Patients will enter the pre-op area where vital signs are taken. For those patients needing sedation an I.V. will be started and medications given. Patients will then enter the procedure room and lie face down on the procedural table with a pillow under the abdomen for lumbar procedures, or face up with a pillow under the head for cervical procedures. An x-ray machine will then be used to localize needle placement to the area where the facet nerve is located. The skin overlying the site of injection is cleaned with antiseptic solution, and covered with sterile drapes. Local anesthesia will be injected to numb the area where the injection will be performed, and nerve location is confirmed. Patients will be asked to inform the physician when they feel these nerve pressure sensations as a stimulating current is applied, and the current may be increased and decreased several times to be sure that the nerve has been properly located. When the nerve localization is complete, the physician will then numb the area and apply microwave or laser energy to the selected nerve branch through the needle or endoscope to interrupt pain signals. At the completion of the procedure the surgical instruments are withdrawn and a bandaid dressing is applied.