Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

A radiofrequency neurotomy is a type of injection procedure in which a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating the facet or sacroiliac joint pain. A medial branch neurotomy affects the nerves carrying pain from the facet joints, and a lateral branch neurotomy affects nerves that carry pain from the sacroiliac joints.

These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs so there is no danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.

Success Rates of Radiofrequency Neurotomy for Pain Relief
Before this procedure is undertaken, the joints and branch nerves will have already been proven to be painful by a diagnostic form of spinal injection, and will not have responded to other treatment methods. If effective, the neurotomy should provide facet or sacroiliac joint pain relief lasting at least nine to fourteen months, and sometimes much longer. After this period of time, however, the nerve will regenerate, and the facet or sacroiliac joint pain may return.

Success rates vary, but typically about 30% to 50% of patients undergoing this procedure will experience significant facet or sacroiliac joint pain relief for as much as two years. Of the remaining patients, about 50% will get some pain relief for a shorter period. Some patients do not experience any relief from facet or sacroiliac joint pain as a result of this procedure.

Anatomy of Facet and Sacroiliac Joint Pain
Facet joints are pairs of small joints that are situated at each vertebral level of the spine. Each facet joint is connected to two medial nerves that carry signals (including pain signals) away from the spine to the rest of the body.

The sacroiliac joints are located at the lowest part of the spine, between the sacrum and ilium in the pelvis, and are also connected to nerves that carry signals to other parts of the body.

Anatomy of Facet and Sacroiliac Joint Pain
As with many spinal injections, radiofrequency neurotomy is best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve injury or other injury). On the day of the injection, patients are advised to avoid driving and doing any strenuous activities. Patients may continue to take any normal medications except aspirin or any other blood-thinning medications, such as Coumadin.

The neurotomy procedure includes the following steps:

  • An IV line will be started so that adequate relaxation medicine can be given, as needed.
  • The patient lies face down on an x-ray table and the skin over the neck, mid-back, or low back is well cleaned.
  • The physician numbs a small area of skin with numbing medicine (anesthetic), which may sting for a few seconds.
  • The physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial or lateral branch nerves.
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