Back Pain Treatments: Facet Neurotomy

Facet Neurotomy is a procedure that targets the nerve supplying the injured facet joint. This is a similar but different procedure than the selective nerve-root block, in which an anti-inflammatory medication is injected into one of the nerve roots exiting the spine.

Why it's done. Facet Neurotomy is one of two procedures that may be performed simultaneously to treat back pain related to inflammation of one or more of the facet joint capsules. The other procedure that may be used is the facet joint block, in which a steroid and/or anesthetic medication is injected directly into the joint capsule. The adjunct procedure, the facet neurotomy, may be effective to enhance pain relief effects of the facet joint block. This procedure, in addition to the facet joint block, may provide additional and longer lasting pain relief. This procedure may provide longer and more powerful pain relief by disabling the nerve responsible for the pain.

How it's done. Facet neurotomy may be performed in an inside or outside of a hospital, in an outpatient setting. To begin, the patient lays on an X-ray table on their stomach. Next, a doctor will deliver the therapy into the affected facet joint, using fluoroscopy. Rather than injecting medication, however, the needle is equipped with a probe, which is then heated with radio waves and applied to the sensory nerve to the back. This delivery of heat to the nerve numbs the nerve, disrupting its ability to send pain signal to the brain.

Prognosis. For patients who have been diagnosed with back pain related to dysfunction of one or more of the SI joints, this treatment is effective approximately 50% of the time.

Facet neurotomy is also known as Radiofrequency Neurotomy for facet and sacroiliac joint pain. While most outpatient procedures at pain management centers to treat back pain involve injections of corticosteroids to areas of inflammation, this procedure involves heat to provide lasting pain relief. This delivery of heat to the nerve is designed to disrupt the pain signals from traveling from the facet joint to the brain. These types of neurotomy procedures may be used to disrupt pain signals on several different types of nerves involved in lower back pain. A medial branch neurotomy blocks the path of pain transmission in nerves traveling from the facet joints. A lateral branch neurotomy blocks the transmission of pain signals traveling from the sacroiliac joints to the brain.

There are minimal risks associates with the lateral or medial branch neurotomy block procedures, especially because these nerves are not associated with sensory or motor functioning in the arms or legs. The medial branch nerves do control small muscles in the neck and back, but the loss of functioning in these nerves does not cause pain or disability, and these changes are not usually permanent.

Short term and long term prognosis. Before this procedure will be attempted, doctors will usually obtain a positive diagnosis of facet joint inflammation either through medical imaging results and through successful treatment with the facet joint block procedure. Facet neurotomy, when done along with facet joint blocks, may provide back pain relief for several months to up to a year and a half.