Your brain works as a supercomputer. To run your body efficiently, it sends and receives signals from most organs and tissues (skin, muscles) through small wires, which are called nerves in medical terms. A short lesson on the basics of human neuroanatomy is important to understand this topic fully. Brain and spinal cord together are considered central nervous system. They are protected well by skull and backbone respectively. It is needless to say that destroying any part of the central nervous system could be devastating, as happens in stroke or spinal cord injury.
The central nervous system communicates with the rest of the body and the world with three different types of nerves (peripheral nervous system):
- Cranial Nerves: These nerves carry important signals of smell, sound, taste and vision directly to the brain.
- Autonomic Nerves: In unsophisticated terms, these nerves help control heart rate, breathing, digestion, urination etc.
- Spinal Nerves: Based on the specific signals they carry, spinal nerves can be
- Sensory (carrying signals of pain/touch/temperature/pain to the spinal cord),
- Motor (carrying signals from the spinal cord to the muscles) and
- Mixed (containing both varieties).
Pain is a partly a sensory and partly an emotional experience. Past experiences of pain help you avoid injuries. When you do get injured, pain helps you avoid further damage to the involved area. In some conditions, pain becomes a nuisance and needs to be blocked. In a perfect world, the only nerves you ever want to destroy are the ones that carry pain signals. The idea of destroying pain carrying nerves has always fascinated scientists and doctors. It can be achieved using a chemical agent (neurolysis), freezing cold temperatures (cryoablation) or heat (radiofrequency ablation or rhizotomy).
Radiofrequency ablation has been used to destroy pain carrying nerve endings from spinal facet joints (medical branches) for a very long time. Recently this technology has been sophisticated to destroy pain carrying nerve fibers of:
- Degenerated disc (IDET, Transdiscal Coolief)
- Sacroiliac joint (lateral branches)
- Hip (articular branches of the obturator nerve and femoral nerve) and
- Knee joint (genicular nerves)
The remainder of this article will focus on facet joint radiofrequency ablation. Please also consider exploring our website to learn more about facet arthropathy (facet syndrome) and medial branch block (an interventional technique to diagnose pain related to facet joint arthritis).
Radiofrequency rhizotomy, also known as neurotomy, is a minimally-invasive procedure for treating nerve pain in the spine. The procedure works by sending pulses of heat energy generated by radio waves to the affected nerves. The goal is to stop these nerves from processing pain signals from injured facet joints, the small joints located between the vertebrae.
Normally this method of pain management is not used unless the patient’s nerve pain has not responded to other more conservative treatments, such as anti-inflammatory medication or physical therapy. The goal of a radiofrequency rhizotomy is to reduce back pain without reducing nerve function. Diagnostic testing is usually performed before the procedure to make sure precisely which nerves are causing the problem.
The Radiofrequency Rhizotomy Procedure
During a radiofrequency rhizotomy, the patient lies face down. The procedure is outpatient, performed either under general anesthesia or under local anesthesia with intravenous sedation. It takes approximately one hour. After numbing the site, the surgeon uses a small needle to penetrate the skin covering the spine. The highly focused heat targets the affected nerve(s), preventing pain signals from being transmitted to the brain.
Fluoroscopy, an imaging technique, is used during the process to ensure that the small needle is inserted accurately into the appropriate facet. Depending on the patient’s condition, the needle may be inserted into more than one place on the spine.
After The Radiofrequency Rhizotomy
Patients should be able to resume normal activities the day after the procedure, although they may expect some soreness, numbness, itchiness or weakness in the targeted region for a few weeks. After about 3 weeks, they should be pain-free. As with most pain management treatments, radiofrequency rhizotomy does not work equally well for all patients. While symptom relief from the neurotomy is always temporary, it may provide comfort for several months or for more than a year.
Risks Of A Radiofrequency Rhizotomy
While the procedure is generally considered a safe one, because nerves are affected there is some element of risk. Although extremely rare, serious complications are possible, including long-term numbness, bladder or bowel incontinence and even paralysis.