Facet PainSacroiliac Joint

What is Facet Neurotomy?

Facet neurotomy is a minimally-invasive neurological procedure that uses radio frequency waves to denerve, or partially disrupt, the nerve supply that goes into the facet joint so that patients suffering from facet arthropathy, SI joint pain or disease in the facet joints of the spine may be relieved of their short- and long-term pain. The denerving procedure is performed by heating the two small medial branches, or facet nerves – the ascending and the descending – of the dorsal ramus that carries the pain signals.  It should be noted, however, that before resorting to facet neurotomy, the patient’s joints and branch nerves will have already been proven by a diagnostic form of spinal injection for its unrelenting pain, and have failed to respond to previously administered treatment methods.

In performing facet neurotomy, the patient is required to lie face down on the procedure table.  Local anesthetic is applied to numb the area where the needle is set to be inserted. Then, with the aid of a fluoroscope, the cannula, or needle-like tube, is cautiously pushed through the path of the medial branch.  After which, the radio frequency electrode is inserted into the cannula to excite the medial branch to determine appropriate positioning of the needle.  This process normally causes a tingling, twitching, and thumping feeling on the patient.  Once the correct position is determined, the radio frequency needle is heated up to 80°C for ninety seconds to temporarily cut or disrupt signal transmission from the medial branch to the brain. Usually both the ascending and descending medial branches are treated simultaneously.  When this is done, the radio frequency needle is removed from the site, and the patient is made to recover in an observation area for at least thirty minutes.

Facet neurotomy is considered as an alternative SI joint pain treatment as well. Depending on the number of levels to be performed, facet neurotomy takes only a maximum of 45 minutes. The patient may resume, with extra care, his usual activities a day after the procedure; although, in most cases, he prefers to rest for a number of days, instead.  It is expected that the patient will experience a very painful feeling over the next few days as anesthetics wear off and the heated nerves are dying from the heat lesions. For this, the doctor may prescribe corresponding pain medications and may advise the patient to apply cool or warm towels over the sore spot.

If the symptoms emanate only from the facet joints, the procedure will provide 70 percent chance of pain relief on SI joint pain that could last between nine to eighteen months. The temporarily disrupted nerves will eventually heal and regenerate, and ready again for a repeat procedure if need be.  Meanwhile, as the patient enjoys the pain relief, he is encouraged to perform physical therapy to strengthen the facet joint(s) that had been treated.

However, it should be noted that just like all other medical procedures, facet neurotomy has also some, albeit rare, potential risks and complications, to name a few: numbness or discomfort around the injection site, especially on the days or weeks following the procedure due to the wearing off of anesthesia and dying of the heated nerves; allergic reactions to medications; permanent nerve pain, and; infection.

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