Introduction
Thoracic facet radiofrequency neurotomy, also known as facet rhizotomy, is a procedure designed to alleviate nerve pain in the upper back, particularly when other treatments have not succeeded. This technique effectively disables the specific nerve responsible for transmitting pain signals, providing relief that typically lasts for about a year, although some patients may enjoy longer-lasting benefits.
Anatomy
The thoracic spine, located in the chest region, consists of twelve vertebrae connected by stabilizing facet joints. Each vertebra has an opening at its center, forming the spinal canal, which houses the spinal cord—a crucial component of the nervous system. The spinal cord extends from the brain, giving rise to spinal nerves that carry signals between the brain and various body parts. Specifically, the medial nerves transmit information regarding pain in the facet joints.
Causes
The primary aim of thoracic facet radiofrequency neurotomy is to deactivate the medial nerve that relays pain signals from the facet joints. These joints are susceptible to degenerative changes, including the development of bone spurs and osteoarthritis, which can lead to what is commonly referred to as facet joint disease or facet joint syndrome.
Symptoms
Facet joint disease manifests as pain in the upper back that may radiate to the ribs and chest. Additionally, it can lead to significant muscle spasms in the upper back, which may dislocate the facet joints.
Diagnosis
To diagnose facet joint disease, your doctor will perform a physical examination and may recommend various tests, including imaging studies, lab work, and nerve assessments. Injection studies can also be utilized to pinpoint whether a specific nerve is responsible for the pain. Thoracic facet radiofrequency neurotomy is typically considered only after other treatment options have failed to provide sufficient relief.
Treatment
The procedure involves using 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 while receiving sedation. The targeted area is then sterilized and anesthetized.
Using fluoroscopy (live X-ray imaging), a needle-like tube (cannula) is carefully guided to the affected medial nerve. A thin electrode is then inserted through the cannula. To confirm the correct placement, a mild electrical current is passed through the electrode, causing the nerve to briefly conduct pain signals, resulting in a muscle twitch. After confirming proper positioning, numbing medication is administered before applying heat through the electrode to create a lesion on the nerve, blocking pain transmission.
Post-procedure, patients are monitored for a brief period before being allowed to return home, typically requiring assistance due to sedation effects. Recovery may involve pain medication, rest, and the application of heat or ice packs to alleviate discomfort.
It generally takes three to four weeks for the treated nerves to fully cease function, during which some pain may persist. Thoracic facet radiofrequency neurotomy often results in pain relief lasting between 9 to 14 months, with some individuals enjoying relief for up to two years. While a minority of patients may not experience any relief, the procedure can be repeated if necessary, as nerves can regenerate over time.
