What is a medial branch rhizotomy and why is it helpful?
A medial branch rhizotomy is a non-surgical procedure which damages the nerves (through very localized heating) that allow you to feel pain caused by your facet joints and on occasion the sacroiliac joints. Your facet or sacroiliac joints have 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 rhizotomy. Theoretically, the pain relief you obtained from numbing the facet or sacroiliac joints themselves and/or their nerve supply (medial branch nerves) should be obtained for 9-14 months after locally heating (destroying) these nerves. In about ½ the patients the pain never returns. The rhizotomy (if technically successful) theoretically prevents the pain signal from traveling through these nerves (from your joints to your brain) so you can't 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.
What will happen to me during the procedure?
An IV will be started and a nurse anesthetist (if necessary) will give you an adequate amount of IV relaxation and pain medicine to keep the procedure comfortable. After lying on your stomach, the skin over your neck, mid-back or low back will be well cleaned. Next, 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 1 minute. This process will be repeated for usually 1-5 additional nerves. The entire procedure takes about 30-90 minutes.
What should I expect after the procedure?
You will go home 30-60 minutes after the procedure. No driving that day. Your neck or back will usually be very sore during the next 1-4 days. This pain is usually caused by muscle spasms and irritability while the medial branch nerves are dying from the heat lesion over the next 7-14 days. Your physician will give you medicine to treat the expected spasms and soreness. Pain relief usually isn't experienced until about 2-3 weeks after the procedure when the nerves have completely died. 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 or may not recur in 9-14 months, or on occasion, sooner. If the pain does recur when the nerves grow back and the nerve signal is re-established you may want to have the procedure repeated with equal success seen in most patients. Some patients never have a return of their pain, but we can't predict when this happens.
Patients frequently ask if when I remove their ability to feel these joints by destroying the nerve, will they still be able to feel or have sensation in or on the other parts of their back?
There is no scientific evidence showing this to be a concern. In the 7 years that we have been following patients after a medial branch neurotomy, we have not seen a patient unable to feel the other parts of their back following the procedure.
There is a rare chance (less than 2%) that you may have increased nerve pain following the procedure for usually 1-3 months. I believe this occurs from increased nerve irritability when the nerve is partially rather than completely damaged. It is usually adequately treated with specific medications and resolves in several months. It is rarer in the mid and low back than in the neck, especially at higher levels (e.g. C2-3) of the neck.
What should I do after the procedure?
You will wait 30-60 minutes in recovery before going home. No driving for eight hours. You will want to substantially limit your activity for 2 days after the procedure which usually includes not working. We try, if possible, to do the procedure on Friday to allow you to rest on the weekend. Please record your pain relief during the following 2-3 weeks on a "pain diary" which we will provide to you. Mail the completed pain diary back to Lansdale Pain Management .