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Medial Branch Rhizotomy


Facet neurotomy is a procedure, which results in interruption of the nerve supply to a facet joint. This interruption known as denervation, is accomplished by a radio-frequency probe that heats and destroys the 2 small nerve branches to each facet joint. These nerves are called the medial branches.

With the patient in a prone position and under local anesthesia and fluoroscopic guidance, a radio-frequency needle is advanced to the base of the transverse processes. The needle is placed along the course of the medial branch. The needle is heated to 70 to 80° C for 90 seconds. At least 2 branches for each joint are treated in this same manner.

The neurotomy takes 30 to 45 minutes, depending on the number of levels to be done. The patient is then recovered in the observation area for 30 minutes to 1 hour.

Increased localized back pain and/or leg pain can be expected from several days to several weeks and rarely several months. Destabilization of the facet joint is a risk and post injection training to strengthen the extensor muscles can prevent this possibility.

Following the neurotomy, there is a 70% chance of pain relief, if the symptoms are only from the facet joints. This typically lasts for 9 months to 1 1/2 years. The nerve eventually grows back and the procedure can be repeated. While the patient is experiencing pain relief, vigorous physical therapy is necessary to try and strengthen the involved facet joint(s). Many patients have a combination of facet and discogenic pain, and require separate treatments.

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