FACET NERVE INJECTION &
RADIOFREQUENCY RHIZOTOMY
Facet nerves are sensory nerves
from the spine that innervate the facet joints sending pain signals to
the brain. The facet nerve injection is a procedure to confirm which
facet joint is the pain generator. If the facet joint injection provides
good but only short term relief, then a facet nerve (medial branch
nerve) injection is recommended and possibly radiofrequency rhizotomy.
Once the pain generator is confirmed the radiofrequency rhizotomy
procedure will follow 1-2 weeks later.
Radiofrequency rhizotomy is a
procedure that disables the sensory nerve via needle with a probe that
is heated with radio waves deadening the nerve and preventing pain
signals from getting to the brain. This procedure provides more long
term relief approximately 8 months to 2 years. The facet nerves do
regenerate and usual pain may return. Radiofrequency rhizotomy may be
repeated without other preliminary injections.
Before the procedure, blood
thinners such as heparin, warfarin (coumadin), aspirin, and
anti-inflammatory medications (except for celebrex) must be discontinued
5 days prior to the procedure date. If you are being treated by any
specialist, medical clearance may be needed to proceed. The morning of
the procedure, you may have something to eat or drink but nothing within
2 hours of the procedure.
At the surgical center an IV
will be started by a nurse. When ready you will be taken to the surgical
suite where you will be placed on your stomach for the injection. This
sterile procedure is performed under IV sedation. The area to be
injected will be prepped and anesthetized with lidocaine (local
anesthetic). Then under fluoroscopic (real time x-ray) guidance, spinal
needle(s) will be inserted and contrast dye injected to confirm the
medication is delivered to the correct location. Then a small amount of
local anesthetic will be injected to each medial branch nerve for facet
nerve injection or a probe for heating and deadening the medial branch
nerve for radiofrequency rhizotomy. During the procedure your vital
signs and oxygen saturation will be continuously monitored. After the
injection, you will be taken to the recovery area and be evaluated. If
your pain goes away after the facet nerve injection, it is highly likely
the specific facet nerve and joint that has just been injected is the
pain generator. You will be monitored until discharge criteria are met.
You will need a family member
or friend drive you home following the procedure. No exceptions.
Following the radiofrequency rhizotomy, it is expected for you to
experience increase pain. Remember nerves don’t like to be touched.
After 2 weeks the pain should subside. You may also experience some
temporary spasms near the injection site. If this occurs use ice or
heat, whichever works best for you. If you are using ice, place a thin
clothe barrier between your skin and the ice pack. Apply for 20 minutes
to the affected area and you may reapply in 60 minutes if needed. If you
are applying heat (moist or dry heat) refer to the manufacturer‘s
instructions for application. Never sleep on a heating pad, burns may
occur.
Complications are rare and
include but not limited to bleeding, infection, damage to nerves and
structures of the spine, spinal headaches, perforation of organs,
collapsed lung, reaction to medications, increased pain, seizure,
stroke, paralysis, damage to fetus if pregnant and death. You may be
given antibiotics during the procedure. Your usual pain may be increased
for a few days after the procedure. The risk of injection of steroids
include thinning of bones, pathologic fractures, weakening of ligaments,
damage to tissues, avascular necrosis of the hip, cataracts, decreased
immunity, reaction to medication. Complications are rare. Side effects
that occur commonly include flushing, fluid retention, rash, weight
gain, insomnia, headache. Diabetics will have significant increased in
blood sugars for a few days and will need to monitor their blood sugar
levels closely and adjust medication as directed by their family
physician. Sedation is used for patient comfort and to facilitate
performance of the procedure. Complications of sedation are very rare
and include aspiration, pneumonia, and loss of airway requiring
emergency resuscitation or surgery. The risk of complications requiring
transfusion is extremely low. The risks of transfusion of blood products
include transfusion reaction, infection such as HIV or hepatitis and
death.
