Cervical facet radiofrequency neurotomy (facet rhizotomy) is used to treat nerve pain in the neck and/or shoulder. This technique is useful for those patients who experience short term relief following local anesthetic blocks of the nerves supplying the cervical facet joints. The procedure “turns off” the specific nerve that carries information about pain. The treatment can provide pain relief for about a year, but can last much longer for some people.
The cervical area of your spine is located in your neck. Seven small bones (vertebrae) make up the cervical spine. Except for the first two vertebrae, a pair of stabilizing facet joints connects each of the bones in the spine. The opening in the center of each bone forms the spinal canal.
Your spinal cord is located within the protective spinal canal. The spinal cord extends from the brain and is a major part of your nervous system. Spinal nerves extend from the spinal cord and travel out of the spine to exchange nerve signals with your brain about specific parts of your body. In particular, medial nerves carry nerve signals about facet joint pain.
Cervical facet radiofrequency neurotomy is used to “turn off” the specific medial nerve that carries information about facet joint pain. The facet joints are vulnerable to “wear and tear” that can lead to abnormal growths (bone spurs), enlarged joints, and osteoarthritis, a degenerative form of arthritis. Also the cervical facet joint is susceptible to trauma caused by hyperextension/hyperflexion injuries. This may be termed “facet joint disease” or “facet joint syndrome.”
Facet joint disease causes pain in the neck that may spread to the back of the head, your shoulders, upper arms, and rarely the hands. Your neck may have powerful muscle spasms, so strong that the facet joints are moved out of position.
Your doctor will examine you and conduct tests to determine if you have facet joint disease. Imaging tests, lab tests, and nerve studies may be used to provide your doctor with more information. Injection studies are used to identify if a specific nerve is conducting the pain signals. Cervical facet radiofrequency neurotomy is used after other forms of treatment have failed to provide long-term relief. Your doctor will let you know if cervical facet radiofrequency neurotomy is a treatment option for you.
Cervical facet radiofrequency neurotomy uses heat to create a lesion (damaged area) on the medial nerve. The lesion impairs the medial nerve’s ability to transmit signals about facet joint pain. Because the nerve is “turned off,” pain is not felt.
A cervical facet radiofrequency neurotomy is an outpatient procedure. You will wear a gown for the procedure and be positioned lying face down on a table. You will receive relaxation medicine before your procedure begins. The back of your neck will be sterilized and numbed with an anesthetic medication.
Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide a needle-like tube (cannula) to the affected medial nerve. A small needle-like electrode (radiofrequency electrode) is inserted through the cannula. To ensure the cannula is in the correct position, a very mild electrical current is delivered through the electrode to the nerve. The nerve will briefly conduct pain signals and cause a muscle twitch, confirming that the correct nerve is targeted. Next, numbing medication is provided to the nerve in preparation for the treatment. Heat is delivered through the electrode to the nerve. The heat creates a lesion on the nerve. The heat disrupts the nerve’s ability to send signals about pain. At the end of the procedure, the cannula and electrode are removed. The process can be repeated for additional nerves that require treatment.
You will be monitored for several minutes before you can return home. You should have another person drive you home because you received sedation. Use care while resuming your regular activities over the next several days because your neck or back will feel sore. Your doctor may prescribe pain medication, rest, and instruct you to use heat or ice packs to ease the pain.
It usually takes three to four weeks for the treated nerves to completely die. During this period, your neck may feel weak. You may experience pain until the treated nerves are dead.
Cervical facet radiofrequency neurotomy typically results in pain relief for about 9 to 14 months or longer. About 50% of people experience pain relief for as much as two years. A small percentage of people do not experience any pain relief from the procedure. Over time, the nerves will grow back (regenerate). Some people will not experience pain again. If you experience pain, the procedure may be repeated.