Radiofrequency Rhizotomy Procedures

If malfunctioning nerves in your spine are causing pain and you can't get relief with standard pain treatments, your doctor may suggest a procedure called radiofrequency rhizotomy. Unlike a standard rhizotomy, in which nerves are cut, radiofrequency rhizotomy uses a probe to burn the offending nerves, preventing them from transmitting pain signals but leaving them otherwise intact. A successful procedure reduces pain without reducing nerve function.

Precautions

• Make sure you're a good candidate for the procedure. The procedure is typically used to treat pain that originates in the small nerves--called facet nerves--that run between your vertebrae. Problems with these nerves can result in pain anywhere along your spine, from trigeminal neuralgia to low-back pain.

  Before recommending radiofrequency rhizotomy, your doctor will ask that you try less invasive pain treatments, such as anti-inflammatory drugs or physical therapy to improve your posture and body mechanics. If your pain has not diminished, you may need additional tests and treatments before your doctor considers rhizotomy. At St. Francis Hospital in Indianapolis, Indiana, for example, patients must have had facet injections, discography tests, or both, before radiofrequency rhizotomy is considered. If it's determined that your pain comes from a specific place on your spine, rhizotomy may be appropriate.

Procedure

• Just before the procedure, the surgical staff will start an intravenous line and ask you to lie on your stomach. Some surgeons use general anesthesia to help reduce the length of the procedure. Others prefer local anesthesia so that you may remain awake and answer questions.

  The surgeon starts by inserting needles into the proper locations on your spine. If you're awake, you'll feel some pressure, but no pain. The surgeon will then test the nerves and, if you're awake, will ask what you feel. After pinpointing the target area, the surgeon will touch a hot, needle-size probe to the malfunctioning nerve. The probe is heated using high frequency electromagnetic radio waves, according to John Fitzgerald, MD, a pain management specialist in Indianapolis. The probe stays in contact with the nerve just long enough to disrupt the pain pathways. In time, says Fitzgerald, the nerve will heal and regrow. But in the meantime, you'll probably have pain relief.

Recovery

• After radiofrequency rhizotomy, you face a very small risk of bleeding or infection. You may feel some temporary numbness, tingling, or weakness in your arms or legs. And your pain might increase for a week or two before it begins to recede.

  In "The Canadian Journal of Neurological Sciences," researchers reported that pain declined by half or more in 40 percent of patients. And according to Michael J. DePalma, MD, Associate Professor of Physical Medicine and Rehabilitation at Virginia Commonwealth University, 60 percent of properly selected patients experience at least a 90 percent reduction in low back pain for 12 months, and 87 percent of patients have at least a 60 percent pain reduction. In about two to four weeks, you'll know how well the procedure worked for you.