RHIZOTOMY

Rhizotomy (can be performed in the back or neck)

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WHAT IS IT? 

Rhizotomy (also called facet medial branch neurotomy) is a procedure to treat back pain. It involves placing needles in the back/neck under x ray guidance to destroy the small nerves that look after the facet joints in the lower back or neck. This takes away the pain from these joints. It is a common pain procedure which has been well studied. It does not affect any movement in the leg.

WHAT IS FACET JOINT PAIN? 

The facet joints are the small joints that connect the vertebrae in the spine at the back while the discs take the weight in the front of the spine.  These joints develop arthritis leading to back pain. Painful facet joints are responsible for 10-20% of all long-term back/neck pain, and up to 40% of back /neck pain in those aged over 65 years. 

Facet joint pain is usually a dull, aching pain, worse in the low back/neck. The pain often radiates into the buttocks and thighs from the back. This radiating nature means it is sometimes mistaken for “sciatica”. The pain tends to be worse with activity and less at nighttime. It is more common in older people but can also occur in the young.  In the neck, it is usually in the neck and can radiate to the shoulder blade and arms but not below the elbow. 

HOW IS THE PROCEDURE DONE? 

The procedure is done in an operating theatre. You will lie on your tummy on an x-ray operating table.  A light general anaesthetic/sedation is given. Local anaesthetic numbs the back. Needles are inserted into your back/neck and are guided to the correct location using X-ray. The treatment is then administered. You will need to be fast for 5 hours before the procedure. You can take your regular medication with a small sip of water.

The procedure takes 30 minutes, and you will go home the same day. 

It is important to know that it can take up to 4 weeks for the pain relief from a rhizotomy to “kick in”. The average duration of relief from a rhizotomy is around 1 year. This can range from 3 months to over 2 years. The procedure can be safely repeated many times afterwards in the setting of a good result.  The pain can get worse after the procedure for 1 week. It is important to keep moving during this time and you may have to take more or stronger pain killers for a short period of time. In some cases, procedure may not help, or you might need a second procedure if your pain area is extensive. You have a 75% chance in general that it will help you.