What is a radiofrequency neurotomy?
In layman's terms Dr. Harries burns the tiny nerves that carry the pain from the facet joints. The burn is performed through a needle. The burn itself is 10mm long (less than ½ inch) and less than a 1/8th of an inch in diameter. The probe is positioned so as to only burn the small pain nerve and not any of the nerves that go to the arms or legs. If you have had good short term benefit from Medial Branch Block, then there is a very good chance of getting good relief from this procedure that typically lasts in excess of 9 months. The procedure can be repeated as necessary.
The spine is a very complex structure made up of a large number of vertebrae. A disk, ligaments and facet joints connect vertebrae to each other. There are two facet joints one on each side between any two vertebrae. The facet joints are known by the names of the two vertebrae they join together. So the facets between the C4 and C5 vertebrae are known as C4\5. Without facet joints our spine would be unable to move. Any movement of our spine requires movement at a facet joint. Because of the movement that occurs at the facet joints they are a frequent cause of pain.
That's a little too simple: please tell me more?
RF helps to decrease pain by interrupting the sensory nerve pathways using a machine called a Radiofrequency Generator. The Generator produces a 500,000 hertz radio wave through a needle placed onto the nerve. This wave causes the nerve to have its electrical transmission interrupted which produces long-term pain relief.
What will happen during the procedure?
You will be asked to lie on your stomach and you will be made as comfortable as possible. Sedation will be given through an IV. The skin will be numbed with local anesthetic. Using an X ray machine for guidance your physician will position a needle correctly over the nerve. When possible the nerve will then be numbed before it is burnt. During the burning some transient discomfort may be felt. This procedure will then be repeated for each nerve in turn. The location of the nerves is marked in red in the illustration. After the procedure, you will be taken to the recovery area and observed for about 30 minutes.
Can I be sedated for the procedure?
Patients are usually sedated for this procedure.
What are the risks of the procedure?
This is a very safe procedure. Feeling faint is the most common problem patients experience. Allergic reaction to medications, bruising and infection are all very rare complications. Approximately 5% of the time patients may experience some burning in their spine or limb after the procedure. This is not something of great concern and is felt to represent the little nerve “dying back”. These symptoms usually resolve within 4 weeks spontaneously. If particularly troublesome, the medications Neurontin or Lyrica may help. When Radiofrequency Neurotomy is carried out at C3 (in the neck), unsteadiness can occur after the procedure and last up to a few weeks. Temporary increase in pain is always a possibility with any procedure; however you will be given a prescription for some pain killers following the procedure.
How long does it take for the procedure to work
The benefits are usually felt within 3 weeks of the procedure although it can take up to 6 weeks.
When can I return to work?
Most patients can return to work the following day. After any procedure, it is possible to develop an increase in pain particularly from muscle spasms. If this occurs you may have to be off work for up to 3 days although this is uncommon.
When can I drive?
You should not drive until the next day.
How long does it last?
The benefits last typically at least nine months. The radiofrequency neurotomy can be repeated in the future if necessary.
What research is there on the effectiveness of this procedure?
Research studies indicate that this is an excellent procedure in those patients who have had good responses to Medial Branch Blocks. This procedure, when carried out in the neck, is probably the most effective of all pain procedures.
