Treatments
2. Radiofrequency Neurotomy of the Z-Joint (Facet) Medial Branch Nerves
Objective: Up to 18 mos. of relief from pain. Symptoms: Pain in the low back or neck. Indicated For: Joint damage to the neck or low back due to trauma (automobile accidents, falls), arthritis, infection, reduced disk height, or repetitive and sustained lifting of heavy objects. Damage might result in eroded cartilage lining, overgrowth of bone (bone spurs), fractures through the joint, tears in the thick fibrous capsule over the joints, or bruising/bleeding into the joints.
Required Evaluation: Pain from the facets cannot be diagnosed by x-ray, CT scan, MRI, or bone scan. Instead, we inject a local anesthetic or other substance directly into the medial branch nerve. If your pain is significantly relieved, you may benefit from radiofrequency neurotomy. If the relief is less than 80%, you may have another spine disease that can be addressed with other therapies.
Pre-Treatment: If you are not scheduled to be sedated, you may eat and drink normally on the day of the procedure. If you are scheduled for sedation, then please refrain from eating or drinking everything (except permitted daily medications) at midnight the day before the procedure. Medications: 14 days prior to the treatment, stop Tclid (ticlopidine). 7 days prior, stop Plavix. 5 days prior, stop Coumadin and Warfarin.
Treatment: The z-joints (facet joints) are located in the back of your spine. They prevent excessive twisting of the spine in the low back, and excessive extension in the neck. In this procedure, we use an x-ray to guide the injection of a medication onto the nerve to the z-joint. For low-back pain, you lie face-down on a soft table, and for neck pain, you lie on your side. After we prepare your skin, we inject a small amount of local anesthesia into the skin. We then guide a thin needle onto the medial branch nerve and inject a small amount of iodinated x-ray dye to assure proper placement. Then, we inject the medication and remove the needle. We may ask you questions about any mild electrical signals or other sensations you are experiencing. Depending on your response, we may repeat this procedure up to three times.
Post-Treatment: We’ll keep you in the Center for up to half hour after the procedure, give you juice, and make sure your head is clear prior to discharge. We’ll also check for leg weakness or numbness. You might need assistance with walking immediately after the procedure. You should refrain from driving for the rest of the day. Driver Needed? Yes.
After discharge, we’ll keep assessing your pain levels. The amount of time it takes for you to feel relief, as well as the degree of relief you feel, will direct further therapy.
Pain Associated with Treatment: Minimal. Anesthetic: Mostly local. In select cases, we might elect to sedate you. Recovery Time: Minimal. Risks: Rare risk of bleeding, infection, abscess, nerve injury, spinal injury, and spinal headache. There’s a greater but temporary risk of dysesthesia: burning-like pain in the low back, buttock, and thigh. Temporary leg numbness may result from the anesthetic.
Discharge Instructions: Resume your normal activity, diet, and medications (unless otherwise instructed). You may experience some numbness in the skin over the back during the first few hours. Relief from the diagnostic injection may last up to 12 hours or longer. Remove any Band-Aids on the following day; if you feel discomfort at the injection site, apply ice wrapped in a washcloth for short periods of time (20 mins per hour) during the first 24 hours, followed by low to medium heat. If you had an IV, there may be soreness and bruising around the IV site that will go away in a few days. A warm moist cloth placed over the area for half-hour periods several times a day will sometimes help.
Notify Us If: You experience numbness of the leg or arms (a possible side effect of local anesthetics.) Also call us if you experience severe, new onset generalized weakness during the first week after the injection, or if you develop fever of more than 102 degrees during the first few days after the injection, or severe increase in back pain. Increased tenderness or red streaking around the area of the IV site, or increasing swelling of the hand, also requires attention
Technologies: This treatment uses a radiofrequency current that interrupts the transmission of pain signals in the nerves.