What is rhizotomy?
This procedure is also referred to as neurotomy, facet denervation, thermo-lesion or thermo-coagulation.
Facet rhizotomy involves “burning” with a radiofrequency device the nerve (the medial branch) innerving the joint facet responsible for the perception of chronic back pain. The procedure is performed once the source of a patient’s pain is identified as being of facet origin through medial branch blocks. The technique involves inactivating the medial branch that innerves a facet and transmits pain signals.
This procedure is indicated for patients suffering from chronic low back pain, who have responded positively to facet blocks but with a short duration or little improvement. To become eligible for facet rhizotomy under radiofrequency, patients must respond positively to a double medial branch block with Xylocaine and Marcaine.
Rhizotomy can provide long-lasting, significant relief to patients suffering from chronic back pain originating in facet joints.
For more information or the make an appointment for rhizotomy at Clinique de physiatrie et de médecine du sport de Montréal, call us today!
A facet joint can be the cause of pain felt at all the levels along the spine. Rhizotomy is indicated for patients who continue to suffer from pain (chronic pain originating from facet joints) despite usual conservative treatment (medication intake, physiotherapy treatment or any other type of therapy and cortisone injection). To be eligible for facet rhizotomy by thermo-lesion, patients must have responded positively to double medial branch blocks with Marcaine and Xylocaine.
When patients are properly selected using the medial branch block diagnostic test, results are generally satisfying. When the pain originates from facet joints, facet rhizotomy by thermo-lesion can provide prolonged relief from one to two years. A second rhizotomy procedure may be considered and performed in the case of recurrent symptoms, if the physiatrist deems it relevant.
After local anaesthesia, an electrode is placed at the site where the medial branch should be inserted. With guidance under fluoroscopic control, the most adequate, precise and safe position of the injection needle is determined. Using a low-intensity electrical current, the physiatrist confirms the right position of the needle with the help of their patient who indicates if the electric current felt is located at the site where there is usually pain.
When the tip of the needle is at the right place, another electric current—this time at a higher intensity—is used to heat the tip of the needle and burn the nerve. To make the procedure as comfortable as possible for patients, a local anesthetic is administered.
This procedure can be performed at several levels of the spine, depending on the physiatrist’s analysis and patients’ response to medial branch blocks.
Following the rhizotomy procedure, patients are taken to a resting and observation room for about fifteen minutes to make sure that there are no allergic reactions to the medication injected.
Patients may experience numbness or weakness in a limb as a result of anaesthesia during the procedure. Symptoms may last anywhere from a few minutes to a few hours, but they will eventually disappear. In the weeks following the procedure, patients may experience numbness or loss of feeling on the skin around the procedure site. This situation is generally temporary.
Complications are extremely rare and generally short-lived. Bleeding and infection, although possible, are unusual. Owing to our experienced staff and the state-of-the-art equipment they used, potential risks are reduced to minimum.
- Prior to procedure, any allergies to medication must be reported to our staff.
- Patients must stop taking anticoagulants and Plavix before the procedure.
- Patients must obtain an authorization to stop taking medication temporarily (antibiotics) from their prescribing physician.
- Patients with pacemakers are not eligible to undergo rhyzotomy.
- Rhizotomy during pregnancy is also contra-indicated.