Introduction
Cervical facet radiofrequency neurotomy, also known as facet rhizotomy, is a medical procedure designed to alleviate nerve pain in the neck and shoulders. This technique is particularly beneficial for patients who find temporary relief from pain through local anesthetic injections targeting the nerves that supply the cervical facet joints. By "turning off" the specific nerve responsible for transmitting pain signals, this treatment can offer relief that typically lasts for about a year, though some individuals may experience relief for an even longer duration.
Anatomy
The cervical spine, located in the neck, consists of seven vertebrae. Each of these vertebrae, except for the first two, is connected by pairs of stabilizing facet joints. The central opening in each vertebra forms the spinal canal, which houses the spinal cord. The spinal cord is a crucial part of the nervous system, extending from the brain and facilitating communication between the brain and various body parts. In particular, the medial nerves convey pain signals originating from the facet joints.
Causes
Cervical facet radiofrequency neurotomy aims to disable the specific medial nerve that transmits pain from the facet joints. These joints can be affected by "wear and tear," resulting in issues like bone spurs, joint enlargement, and osteoarthritis, a degenerative condition. Additionally, the cervical facet joints are prone to injury from hyperextension or hyperflexion, leading to conditions referred to as "facet joint disease" or "facet joint syndrome."
Symptoms
Individuals with facet joint disease often experience neck pain that can radiate to the back of the head, shoulders, and upper arms, with rare instances of pain extending to the hands. This condition may also trigger intense muscle spasms in the neck, which can dislocate the facet joints.
Diagnosis
To diagnose facet joint disease, your doctor will perform a physical examination and may conduct various tests, including imaging, laboratory tests, and nerve studies. Injection studies are often utilized to pinpoint the specific nerve responsible for the pain signals. Cervical facet radiofrequency neurotomy is typically considered after other treatments have failed to provide lasting relief. Your doctor will evaluate whether this procedure is suitable for you.
Treatment
Cervical facet radiofrequency neurotomy employs heat to create a lesion on the medial nerve, effectively impairing its ability to transmit pain signals from the facet joints. This outpatient procedure begins with the patient lying face down and receiving a sedative. The back of the neck is sterilized and numbed with local anesthesia.
Using fluoroscopy for real-time imaging, the physician carefully inserts a cannula to reach the affected medial nerve. A radiofrequency electrode is then guided through the cannula to deliver a mild electrical current, which confirms the correct nerve target by causing a brief muscle twitch. Once the correct position is verified, the nerve is numbed, and heat is applied to create a lesion, disrupting the nerve's pain signaling capabilities. After removing the cannula and electrode, the procedure may be repeated for any additional nerves that require treatment.
Following the procedure, you will be monitored briefly before being discharged, but you will need a designated driver due to sedation. Over the next few days, as the neck or back may feel sore, it is essential to take care while resuming normal activities. Your doctor may recommend pain relief strategies, including medication, rest, and the application of heat or ice packs.
It generally takes three to four weeks for the treated nerves to completely die. During this time, some individuals may experience weakness or pain until the nerve function ceases. Most patients experience significant pain relief for approximately 9 to 14 months, with about 50% of individuals reporting relief lasting up to two years. While a small percentage may not experience any relief, some may find that the pain does not return after the nerves regenerate. If pain reoccurs, the procedure can be performed again.
