The facet joints, pairs of small joints on the back of the spine providing for its stability and allowing for its flexibility, are primary sources of pain for many individuals. The severity, frequency and duration as well as the location of the pain depend on the site of the problematic facet joints, said pain of which can be in the chest, ribs and middle back as well as in the legs, neck and shoulders. When facet joint injections containing steroid medications fail at providing pain relief, rhizotomy (cervical/lumbar) may be the next best option.
What Is It?
In both cervical rhizotomy and lumbar rhizotomy, the goal is to provide complete pain relief by blocking off the pain signals sent by the injured or diseased facet joint to the brain. This is a spinal procedure with fluoroscopy technology as the primary means of administering the injections. Patients can enjoy pain relief for months, even years, when the procedure is performed properly by a qualified doctor. The success rates for the procedure are high, thanks to the high-tech equipment used by surgeons in hospital and clinical settings.
Who Should Consider It?
The rhizotomy (cervical/lumbar) procedure is most commonly used for children and adults with spastic cerebral palsy particularly those with spastic diplegia. If you are a parent to such a child or an adult, keep in mind that not everybody with the medical condition will benefit from facet rhizotomy so thorough discussions with your doctor must be made.
For example, in children under 18 years of age, cervical rhizotomy or lumbar rhizotomy can only be performed when the patient has a diagnosis of spastic quadriplegia, spastic diplegia or spastic hemiplegia coupled with a certain degree of independent mobility, potential for advancements in functional skills, and no severe injury on the basal ganglia. For adults, a similar set of criteria apply with the addition of the intense motivation to actively participate in an intensive physical therapy and home care program.
How Is It Done?
Both types of rhizotomy (cervical/lumbar) are in-patient procedures requiring overnight hospitalization. You will be required to change into a clean hospital gown before the procedure.
The steps can be summarized as follows:
- You will lie down on the operating table.
- Your doctor will clean, sterilize and mark the injection area. He will administer a local anesthetic, use x-ray guidance technology (fluoroscopy), and place a needle with an electrode at its tip. He will heat up the electrode with radiofrequency technology, which will then be applied to the nerves. This will deaden the nerves carrying the pain signals to the brain.
- Your doctor will then withdraw the needle after the procedure is finished and will clean up the treatment area.
A new type of rhizotomy (cervical/lumbar) procedure uses pulsed radiofrequency, which stuns the nerves instead of burning the nerves. Your doctor will decide which of these two options are best in your case although it must be emphasized that the success rates for both are high and that there are little to no serious complications.
What Should Be Done After It?
You may experience soreness, swelling and bruising at the injection site but these are temporary. You can resume your normal activities a day after the rhizotomy (cervical/lumbar) procedure but home care measures should be followed for best results.