St. Luke's University Health Network

Medial Branch Neurotomy

Cervical, Thoracic and Lumbar Medial Branch (Facet) Radiofrequency Neurotomy (Rhizotomy)

What is a medial branch neurotomy and why is it helpful?

A medial branch neurotomy is a non-surgical procedure which cauterizes the nerves (through very localized heating) that allow you to feel pain caused by your facet joints. Your facet has been proven to be painful by diagnostic injection procedures, but your pain has not been reduced by other treatment methods. Likely, we have previously numbed the medial branch nerves to see if you were a candidate for the neurotomy. The pain relief you obtained from numbing the facet nerve supply (medial branch nerves) should persist for several months after locally heating
(cauterizing) these nerves.

In some patients, the pain never returns. The neurotomy (if technically successful) theoretically prevents the pain signal from traveling through these nerves (from your joints to your brain) so you cannot feel or sense your injured and/or diseased spinal joints. These medial branch nerves do not control any muscles or sensation in your arms or legs. They only allow you to feel these joints and small nearby ligaments and control a short, small muscle (multifidus muscle) in your neck, mid-back or low back. Studies have shown that there is no functional or clinical significance from ablating the multifidi muscles.

What happens during the procedure?

Lying on your stomach, the skin over your neck, mid-back or low back will be well cleaned. The physician will numb a small area of skin with numbing medicine which may sting for a few seconds. The physician will use X-ray guidance to direct a special (radiofrequency) needle along side the targeted medial branch nerve. A small amount of electrical current will be carefully given through the tip of the radiofrequency needle to assure the needle is precisely next to the target medial branch nerve and not any other larger nerves. This may, for a few seconds, recreate your pain and cause a muscle twitch in your neck or back. The medial branch nerves will then be numbed so you will feel little to nothing while the nerve is being heated (locally destroyed) for one minute. This process will be repeated for usually one to five additional nerves. The entire procedure takes about 30 minutes.

What should I do after the procedure?

You will wait 30 to 60 minutes in recovery before going home. You may not drive for eight hours. You will want to substantially limit your activity for two days after the procedure.

What should I expect after the procedure?

Your neck or back may often be moderately sore during the next one to four days. This pain is usually caused by muscle spasms and irritability while the medial branch nerves are disrupted from the heat lesion over the next 7 to 14 days. Your physician will give you medicine to treat the expected spasms and soreness. Pain relief usually isn’t experienced until about two to three weeks after the procedure when, on occasion, your back or neck may feel slightly weak for several weeks after the procedure.

The nerves will eventually grow back (regenerate) but the pain may not recur in 9 to 14 months, or on occasion, sooner. If the pain does recur when the nerves grow back and the nerve signal is re-established, you may have the procedure repeated with equal success seen in most patients. Some patients never have a return of their pain, but we cannot predict when this happens.

General Pre/Post Instructions

Eating

You may eat a light, but not full meal at least six hours before the procedure. If you are an insulin dependent diabetic do not alter your normal food intake.

Medications

Take your routine medications before the procedure (such as high blood pressure and diabetes medications) except for those that need to be discontinued five days before the procedure such as aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro). These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are taking Coumadin, Heparin, Lovenox, Plavix or Ticlid you must notify the office so that the timing of stopping these medications can be explained.

Exercise

You must bring a driver with you. You may return to your current level of activities the next day including return to work.

Things that may Delay the Procedure

If you are on antibiotics please notify our office; we may delay the procedure. If you have an active infection or fever we will not do the procedure.