Thoracic facet radiofrequency neurotomy (aka facet rhizotomy, radiofrequency thermocoagulatrion, and radiofrequency ablation) is a minimally invasive procedure used to treat facet joint related nerve pain in the upper back. This treatment essentially “turns off” the specific nerve that is carrying pain signals to the brain.
There are a number of reasons why facet joint pain develops. Common causes include:
- Degerative disease of the spine
- Trauma or injury
- Natural “wear and tear” as we age
- Bone spurs
In the absence of injury or accident, degenerative disease of the spine is often the cause of facet joint pain. Therefore, facet joint syndrome is more commonly seen in older patients. Pain can arise due to the deterioration of cartilage lining the facet joints along the spine. When this occurs, the bones may rub directly against each other, which can lead to back and neck pain.
Diagnosing Thoracic Facet Joint Pain
If you are experiencing chronic upper or middle back pain, then a diagnostic procedure called medial branch block can be performed to help identify if your symptoms are related to facet joint pain. Each facet joint is connected to two medial branch nerves that carry signals (including pain signals) to the brain. A diagnostic medial branch block involves the injection of a small amount of local anesthetic over the nerves(s) suspected to be the origin of the pain. The numbing agent temporarily disrupts the nerve’s ability to transmit information about facet joint pain to the brain. If the patient experiences a significant reduction in pain during this time, it is likely that the pain source has been located.
Treating Facet Joint Pain in the Upper Back
Once it is established that thoracic facet joint pain is the cause of your symptoms, your physician may recommend a series of facet joint injections. This treatment involves the delivery of a long acting anti-inflammatory steroid directly into the facet joint. For some patients, these injections are sufficient in providing months of sustained pain relief.
If facet joint injections fail to provide the patient with the relief they need, then thoracic facet radiofrequency neurotomy may be recommended. This procedure reduces or stops pain originating from the facet joints by interrupting the nerve’s pain signals and therefore decreasing the brain’s perception of pain.
How is Thoracic Facet Radiofrequency Neurotomy Performed?
This is a minimally invasive procedure typically performed with mild sedation and local anesthesia. The procedure begins with the patient lying face down on a table. The treatment site is sterilized and a local anesthetic is administered to increase patient comfort during the procedure. Using a live x-ray device (fluoroscopy) your doctor will carefully guide a specialized needle (known as a cannula) to the nerve. A small wire-like electrode is inserted through the cannula and a very mild electrical current is delivered, stimulating the targeted nerve and verifying correct placement of the needle.
Once your physician has confirmed that the needle is placed properly, a numbing agent is then injected onto the nerve. Next, heat energy is delivered to the sensory nerve via the electrode. This creates a heat lesion, which disrupts the nerve’s ability to transmit pain signals to the brain. When the procedure is completed, the needle and electrode are removed and a bandage is placed over the injection site. The patient is monitored for a short period of time before being discharged home with instructions.
The effects of radiofrequency neurotomy can last for many months to years, providing the patient with prolonged pain relief. The treated nerve(s) will regenerate eventually and may begin transmitting pain sensations again, at which point the procedure can be repeated.
Schedule an Appointment to Discuss Upper Back Pain Management
If you are experiencing upper back pain, please contact the Diagnostic Pain Center today at (512) 981-7246. There are a number of non-invasive and minimally invasive treatments available to manage and treat back pain. Austin pain management physicians Dr. Robert S. Marks, Dr. Sauman A. Rafii, and Dr. Ivan N. Chew will work closely with you to identify a solution and get you back to your normal activities as quickly as possible.