Radiofrequency Nerve Ablation or Neurotomy
As stated above, the neck and back has many joints which work together to keeps the spine moving as one piece with a great deal of flexibility. These joint can get arthritic or inflamed and cause pain due to many reasons – normal wear and tear or mechanic trauma are the most common. Medial branch nerve block delivers medication to the nerves that supply the sensation to these joints; in an effort to decrease pain and inflammation to determine if this is the cause of a patient’s neck or back pain. With a positive medial branch nerve block that has provided pain relief or an increase in mobility, then is it possible to proceed to ablate or destroy the nerve.
During the procedure, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area, is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the area of interest is identified and the skin is anesthetized. Using a small needle, the nerve going to the identified painful joint is identified under fluoroscopy. The location of the nerve is further identified by sensory and motor testing using a special machine. Local anesthetic is injected into the area to numb it before radiofrequency thermal energy is applied to disrupt the nerve. A solution of anesthetic and steroid is injected after the procedure to decrease inflammation in the area. The disruption of this nerve is not permanent as the nerve grows back, but it can provide pain relief up to six to nine months.