Lumbar Radiofrequency Neurotomy

What is lumbar radiofrequency neurotomy?

Lumbar Radiofrequency Neurotomy, also known as radiofrequency rhizotomy (RF) is a minimally invasive procedure that eliminates back pain in the lumbar (lower) region of the back. This lower back pain is a result of damaged facet or sacroiliac joints. The facet joints are the joints made up of the vertebrae, and each joint connects to two medial nerves. Lumbar radiofrequency neurotomy is generally recommended for patients who have tried alternative methods of pain relief, like medication and physical therapy.

The operation is performed with local anesthetic, and successful surgeries can lead to full pain relief within a month of the surgery. A study published in the medical journal Spine reported that at least 60% of patients in the study received 90% pain relief in the lumbar region after one year, and 87% of the patients received at least 60% pain relief after one year. The procedure, however, is generally not permanent and the pain relief often subsides after a year or so, requiring the procedure to be repeated.

What happens during a lumbar radiofrequency neurotomy?

During the surgery, the surgeon will use a small tube called a cannula to navigate toward the spinal nerves. The surgeon will use a fluoroscope (a real-time x-ray machine that allows the surgeon to see exactly what is going on inside the body and where the instruments are in relation to the spine) to correctly place the cannula near the appropriate spinal nerves. The surgeon will place the cannula near the medial branch nerves. These nerves send pain signals to the brain from the lower back. The purpose of the surgery is to disrupt the nerves’ ability to send those pain signals.

After the cannula is put into position, the surgeon inserts a radiofrequency electrode and uses a weak jolt to shock the patient and trigger the nerve. If the jolt causes no other muscles to move, the electrode is in the correct place.

After the electrode is in the correct space (where it affects only the nerves and no muscles), the electrode is heated and then used to cauterize or sever the nerve. After the nerve is cauterized, it can no longer send pain messages to the brain, so the patient will no longer be in discomfort. To completely relieve back pain, the surgeon may have to cauterize more than one medial branch nerve. It will take between two to three weeks for the nerves to become completely blocked by the cauterization. During these intervening weeks, the patient may still suffer from back pain similar to that which they experienced before the surgery.

What is the recovery period like for a lumbar radiofrequency neurotomy?

Radiofrequency neurotomy is considered an out-patient procedure, and because it is performed with only local anesthetics, patients will return home the same day as their procedure. Pain near the site where the cannula was inserted will generally last one week until the site heals. Patients may receive a prescription for pain medications to help with the healing and soreness of the incision site, but will generally be able to return to normal activities shortly after the surgery.

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