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Thoracic Facet Joint Radiofrequency Rhizotomy

What does “Thoracic Radiofrequency Facet Joint Rhizotomy” mean?

Here is the meaning of each word:

  1. Thoracic: the part of the spine located in the mid-back
  2. Facet Joint: small joint on the back of the spine
  3. Radiofrequency: a form of energy which can produce heat
  4. Rhizotomy: to disrupt a nerve

Altogether, “Thoracic Radiofrequency Facet Joint Rhizotomy” means placing targeted heat energy onto a nerve in the mid-spine to disrupt pain from a facet joint.

Why is a Thoracic Radiofrequency Facet Joint Rhizotomy done?

This procedure is often done to relieve pain from an inflamed facet joint. The hope is that this procedure may last longer than a steroid injection of the facet joint.

How does Radiofrequency Energy disrupt a nerve?

Radiofrequency energy can deliver very target high temperature energy to a nerve. This energy disrupts the nerve’s ability to transmit information. In the case of a facet joint nerve (medial branch), the nerve cannot send information to the spinal cord and brain that the facet joint is inflamed and painful. So, even if the facet joint is inflamed, no pain is felt.

What is the difference between a Thoracic Facet Joint Injection, and a Thoracic Radiofrequency Facet Joint Rhizotomy?

    1. A thoracic facet joint injection is done by injecting a medication into the joint itself to either diagnose the source of the pain or treat inflammation.
    2. A thoracic radiofrequency facet joint rhizotomy is done to disrupt the small nerves traveling to the facet joint in hopes of relieving pain for the longer term.

How is a Thoracic Facet Joint Rhizotomy done?

Here are the steps of how the procedure is done:

  1. The patient is brought to a Procedure Room or Operating Room.
  2. An intravenous catheter (IV) may be placed and relaxing medication is often given (sedation).
  3. The patient is placed on their stomach (prone).
  4. The mid-back (thoracic spine) is then cleaned with surgical antiseptic and sheets (drapes) are placed around the site to keep it clean.
  5. An X-Ray machine (C-Arm) is then used to see the facet joints.
  6. Local anesthetic medication is injected under the skin.
  7. A specialized needle (radiofrequency needle) is then placed through the anesthetized skin and advanced to a location next to each facet joint. This is done with the help of the X-Ray machine.
  8. The specialized needles are hooked up to a radiofrequency generator (machine which generates radiofrequency energy).
  9. The radiofrequency generator is turned to a certain frequency which sends impulses to the nerve. This stimulates the nerve and gives the patient a similar sensation as their usual symptoms. This may be felt as slight pain, tingling, or pressure.
  10. Next, the radiofrequency generator is turned to a different frequency. On this frequency, the larger nerves which give you movement (motor) are tested. The doctor does not want the specialized needle (radiofrequency needle) to be too close to these nerves.
  11. Now, the radiofrequency generator is turned to a setting where it can deliver a very targeted radiofrequency energy in the form of heat.

The doctor choses the temperature, and the time interval of how long this temperature is delivered to the nerve. Just prior to delivering the heat energy, the doctor often injects a local anesthetic onto the nerve to lessen any discomfort from the heat energy.

  1. Once all the nerves are treated in this fashion, the needles are withdrawn.
  2. Sterile band-aids are placed over each injection site.
  3. The patient is then taken to a Recovery Area for observation.

How long does it take to do a Thoracic Facet Joint Radiofrequency Rhizotomy?

Depending on how many spinal levels have to be treated, the procedure can take about 15-30 minutes or more to complete.

What benefit can patients gain from a Thoracic Facet Joint Radiofrequency Rhizotomy?

The benefit from this procedure can vary. Patients who respond well, can get pain relief for 6 months or more.