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Lumbar Radiofrequency Neurotomy - Pain Management

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Introduction

Lumbar radiofrequency neurotomy (facet rhizotomy) is used to treat nerve pain that originates in the spine joints of the lower back. Lumbar radiofrequency neurotomy is useful for people that experienced relief following nerve blocks to the area. The procedure “turns off” the specific nerve that carries information about pain. The treatment provides pain relief for about a year, but can last much longer for some people.

Anatomy

The lumbar area of your spine is located in your lower back and forms the curve below your waist. Five large bones (vertebrae) make up the lumbar spine. A pair of stabilizing facet joints connects the bones in the lumbar 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.

Causes

Lumbar 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. This may be termed “facet joint disease” or “facet joint syndrome.”

Symptoms

acet joint syndrome in the lumbar spine can cause pain in the lower back, buttocks, and the backs of the thighs. Pain and stiffness may make it difficult for you to stand up or move. For example, it may be challenging to rise from a chair.

Diagnosis

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. Lumbar radiofrequency neurotomy is used after other forms of treatment have failed to provide long-term relief. Your doctor will let you know if lumbar radiofrequency neurotomy is a treatment option for you.

Treatment

Lumbar 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 lumbar 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. Your lower back area 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 delivered to the nerve in preparation for the treatment. Heat is delivered through the electrode to the nerve. The heat creates a lesion in the nerve. The heat disrupts the nerve’s ability to send signals about pain. At the end of the procedure, the tube and probe 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. You should use care while resuming your regular activities over the next several days because your 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 turn off. During this period, your back may feel weak or odd. You may experience pain until the nerves are dead.

Lumbar radiofrequency neurotomy typically provides symptom relief for about a year or longer. Physical therapy can help you regain strength and flexibility so that you can resume your favorite activities. If you experience pain, the procedure may be repeated.


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