Facet joint denervation by radio frequency lesioning (Rhizolysis)

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What is it?

It is a procedure done using a specilised machine to interrupt nerve conduction, on a semi permanent basis from the small nerves to the facet joints. The nerves are then blocked for few weeks to months.

How does it work?

It works by a special process of heating the nerves so that the nerve conduction is interrupted for long time. The process is called radio frequency lesioning. (Pain relief thus should be long lasting.i.e.few weeks to months.) It is used for conditions such as neck or back pain, if the source of the pain has been proven by the test facet nerve blocks. Other indications include abdominal pain which has responded to local nerve block.

What does the treatment involve?

The procedure is carried out in the aseptic manner to minimise the risk of infection so you will be asked to change in the hospital gown. It is performed either in the operating theatre or X ray department. The doctor will explain the procedure and ask you sign the consent form. The facet joints are located under x ray control.

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You will be asked to lie flat on your tummy, for the lower back and the skin is cleaned with antiseptic and numbed with the local anaesthetic and the nerves are located with the help of the needle under X ray guidance. A Small amount of sedative medication may be given to you. Electrical stimulation is then applied to nerves.  You will be asked to report any sensation in your back. Once the nerves are located small heat current is passed down the tip of the needle so that they are destroyed. The process is repeated in each of the joints. The sterile dressing is then put on the area. The whole procedure takes about 30-45 minutes depending on how many joints are denervated. You will be taken to the recovery area and blood pressure checked. You will be offered a hot drink. You may go home after about 2 hours.

What happens after the treatment?

Initially you might feel soreness in the muscles for few days. Ice packs and usual painkillers will help to control this discomfort. You might start getting the pain relief after a week or so. You might want to take next day or two easy but can go back to work if you feel up for it. You will be followed in the pain clinic after few weeks to see how the treatment has worked for you.

What are the risk and side effects
Generally speaking this procedure is safe. However as in any procedure there are risks and possibility of complications. There is small risk of infection therefore the sterile conditions are used. The needle goes quite close to the blood vessels and other nerves so they can potentially be damaged, so great care is taken to place the needles and test before the treatment. Sometimes if the nerves cannot be located reliably, then only injections of pain relieving drugs is carried out in that session.