Facet joints are the paired joints that connect vertebrae in the spine. They are important for both range of motion and stability.
Over time and with physical stress these joints can erode, enlarge and become arthritic. Facet arthropathy can further cause back spasm and referred pain that are frequently indistinguishable from sciatica or discogenic radicular pain.
Facet Medial Branches are the small branches of spinal nerves that innervate these joints. Facet blocks are an important component injection technique for diagnosing and treating pain from facet arthropathy.
Facet medial branch blocks help to reduce pain from joints and muscles and facilitate physical rehabilitation. Radiofrequency thermocoagulation (RFTC) medial branch rhizotomy which is used to ablate these small nerve branches utilized for long-term pain relief.
Radiofrequency ablation or lesioning is a treatment utilizing radiowaves and heat to destroy tissue, in our case a nerve, for pain relief. Radiofrequency has also been used for treating fast heartbeats and tumors with great success.
Radiofrequency rhizotomy (or RFTC, radiofrequency thermocoagulation) of the spinal facet joints provides significant pain relief in well selected patients with facet joint syndrome which can include symptoms of neck pain, back pain, arm pain, gluteal pain and leg pain.
RFTC is an outpatient procedure performed under local anesthesia. Sometimes intravenous sedation is used to help the patient relax. During the procedure, radiofrequency waves are transmitted through the tip of a specialized needle placed into the facet joint under x-ray guidance. The heat generated from the needle coagulates the nerve and renders it non-effective for transmitting pain impulses – thus providing pain relief.
After the procedure, the patient will be taken to the recovery room for a brief period of monitoring, and for instructions before discharge.
RFTC is a safe, non-surgical treatment. There are a few possible complications related to RFTC but the risk is low. Your doctor will glad to explain the procedure and the risks to you in detail and answer any question that you may have.
Immediately following the procedure, you may have some local numbing but this will be only temporary.
You may experience an increase in pain and/or muscle spam for the first several days following the procedure. Additional pain medications or muscle relaxants may be necessary to help you stay comfortable.
Drink lots of fluids and eat foods with plenty of fiber. If constipation should occur you may need to use an over-the-counter laxative.
You may notice some swelling and bruising at the needle sites. Using a cold pack will ease the discomfort.
You will be given an instruction sheet on what to do and whom to call should you have any question or concern.
Your doctor will arrange a follow-up appointment or phone consult within three to four weeks after the procedure to see how you are doing.
The degree of pain relief varies from person to person. The maximum decrease in pain may take up to three or more weeks to occur. You can eventually expect 50 percent or greater pain relief. Pain relief can last from six to12 months, or longer. The nerves do repair themselves and your pain may return. The procedure can be repeated if the pain returns some later time.
Why is rehabilitation important after RFTC?
It is important that you start a program of conditioning, strengthening, and range of motion exercises after radiofrequency ablation. Ideally, increased muscle strength around the arthritic joints will make pain relief more prolonged after radiofrequency ablation. With rehabilitation, when the nerves do regenerate, you will not likely experience the same intensity of pain as before the procedure.
You may be prescribed a formal physical therapy program after undergoing the RFTC procedure.
For more information, or if you should have more questions, please contact our office to speak to one of our staff.