The facet joints are often the primary source of pain for
many back pain sufferers. Facet joints are small joints
located in pairs on the back of the spine that provide
stability to the spine and allow the spine to move and be
Depending on where the problematic facet joints are
located, they can cause pain in the mid-back, ribs, chest
(thoracic facet joints), lower back, abdomen, buttocks,
groin, or legs (lumbar facet joints), neck, shoulders, and
even headaches (cervical facet joints).
Facet joint injections of steroid medications are often
given to patients with this type of pain. The injections not
only provide pain relief, but they can also help the
physician pinpoint exactly where the pain originates and can
confirm or reject the facet joints as the source of the
pain. For many patients, facet joint injections provide
adequate relief. For others, however, the pain relief is too
short-lived. For these patients, facet rhizotomy (also
called radiofrequency rhizotomy) may be the answer.
What Is Facet Rhizotomy?
The goal of a facet rhizotomy, either a cervical facet
rhizotomy or lumbar facet rhizotomy, is to provide pain
relief by "shutting off" the pain signals that the joints
send to the brain. The pain relief experienced by most
patients who have this procedure lasts months or even years.
How Facet Rhizotomy Is Done
Patients who are candidates for rhizotomy typically have
undergone several facet joint injections to verify the
source and exact location of their pain. Using a local
anesthetic and x-ray guidance, a needle with an electrode at
the tip is placed alongside the small nerves to the facet
joint. The electrode is then heated, with a technology
called radiofrequency, to deaden these nerves that carry
pain signals to the brain.
Serious complications with facet rhizotomies are rare. A
new technique using pulsed radiofrequency does not actually
burn the nerve, but appears to stun the nerve. This
technique appears to be even safer than the regular
radiofrequency technique, but does seem to have the drawback
of not lasting quite as long. Some specialists (such as the
author) prefer to use the pulsed technique in higher risk
areas such as the neck.
The procedure takes about 30-60 minutes. Afterwards,
patients are monitored for a short time before being
What to Expect with Facet Rhizotomy
Very little preparation is required for a facet rhizotomy
- Your physician will give you detailed instructions
about whether you can eat before the procedure.
- In most cases, you can continue to take your usual
medications before a rhizotomy. However, make sure you
discuss what medications you use with your physician
before the procedure.
- Since a rhizotomy requires the use of a local
anesthetic, you may need someone to drive you home after
Once you are ready, you will be given an IV with a mild
sedative to keep you comfortable but awake during the
procedure. A local anesthetic will be used to numb the area
where the injection is to be done. An x-ray machine is then
used to guide the exact placement of the needle/electrode.
Once the needle is injected, a mild electrical current is
used to stimulate the nerve and confirm its exact location.
You may feel slight pressure or tingling during this part of
the procedure. Then the electrode is heated to deaden the
sensory nerves. When the procedure is completed, the needle
is removed and the injection site is bandaged.
After the Procedure
Some initial discomfort may be experienced immediately after
the procedure, including bruising, soreness, or swelling at
the injection site. However, most patients are able to
return to work and their normal daily activities the
Also, your back may be sore for a few days after the
procedure. This is procedure-related pain and can be treated
successfully using ice packs or over-the-counter pain
medications. After a few days, you should begin to notice an
improvement in your usual pain and can expect continued
improvement over the next several weeks.
Side Effects of Facet Rhizotomy
Serious complications are rare, however contact your
physician if you experience any of the following:
- Prolonged pain at the injection site
- Numbness that lasts more than 2-3 hours
- Bleeding or drainage at the injection site