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Radiofrequency Nerve Ablation

cervical, thoracic, lumbar

Facet Joint/Medial Branch Nerve Rhizotomy

Texas Pain Management Institute offers a variety of minimally invasive pain treatment procedures that we have perfected to help you achieve pain relief. Our treatments have been proven effective and are on the cutting edge of science related to pain reduction. Our goal is to improve every patient’s overall function and thus restore a better quality of life.


Facet joints are small joints located on the outside of the spinal column. These are synovial joints (much like the knee joint) and are responsible for the full motion in our spine. Without facet joints our movements would be very stiff and limited. Unfortunately these joints can often become inflamed or injured by processes such as whiplash injury, degeneration of the spine, arthritis in the spine or spinal surgery. Facet joints are found in the lumbar spine (lower back), thoracic spine (mid back) and cervical spine (neck). These joints are innervated by a very specific set of nerves – medial branch nerves. Medial branch nerves are responsible for the transmission of pain from these damaged facet joints. It is impossible to determine the exact origin of pain from physical exam and imaging studies such as CT scan or MRI. Sometimes a “diagnostic nerve block” is needed. Only after TWO diagnostic medial branch blocks (please refer to facet joint/medial branch diagnostic nerve blocks) will you be considered for a facet joint/medial branch rhizotomy. A medial branch rhizotomy is performed with a specialized needle which delivers radiofrequency heat directly to the medial branch nerve, thus destroying the nerve and reducing the pain associated with facet joints.

Conditions commonly treated with facet joint/medial branch rhizotomy:

  1. Failed back surgery syndrome – continued pain despite surgery to the spine
  2. Spondylosis – osteoarthritis causing degeneration of the facet joints
  3. Lumbago – lower back pain
  4. Cervicalgia – neck pain
  5. Scoliosis – abnormal curvature of the spine

The procedure:

(please refer to our Pre-procedure Instructions for specifics)

Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation and nitrous oxide gas (laughing gas) to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified a tiny needle will be placed under continuous x-ray guidance onto the site of the medial branch nerve. A total of four needles are typically placed on each side. Needle placement is confirmed in both AP (up and down direction) as well as lateral (side to side direction) with contrast dye. The needle is then tested for both sensory and motor function. During the sensory test you may actually feel discomfort in the area you typically have pain. Do not worry this is normal and actually is viewed as a good sign, because it shows the needle placement is correct. Motor testing is then done. During the motor testing you may feel some “muscle twitching” or even possibly your entire leg or arm jumping. Once the position of the needles has been tested and the sensory and motor function are acceptable, local anesthetic (numbing medication) is injected. The needle tip will then be heated with a specialized machine to 90 degrees Celsius for 60 total seconds at each level. The needles are then removed and the procedure is repeated on the same side.

Post Procedure Instructions

What to expect after procedure:

The rhizotomy procedure may produce some increased pain for a few days after the procedure. Pain after rhizotomy is typically described as a “burning, numbness or sunburned skin” type feeling. Do not worry as this is normal and can be expected due to the destruction of the nerve. Taking anti-inflammatory medication (advil, aleve, ibuprofen and naproxen) and placing ice on the procedure site will typically help this pain. Most patients do not experience the full pain relief from their rhizotomy procedure for up to 3-4 weeks. Rhizotomy pain relief may last anywhere from 6 months to two full years. The nerve will eventually grow back and this causes return of the pain. Rhizotomy may be repeated every 6-8 months if needed.

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