Radiofrequency Lesioning/Neurolytic Procedures/Rhizotomies
Why is this procedure done?
Radiofrequency ablation (rhizotomy) is a procedure where high-frequency radio waves are used to generate heat and cause a lesion along a nerve that supplies sensation to a joint in your spine. This procedure is done after diagnostic lumbar facet joint/medial branch blocks have correctly identified the location of your arthritic spinal pain (cervical or facet joints). All nerves regenerate over time, so the results will not last forever; however, many patients experience pain relief that lasts six months to over a year.
How is the procedure done?
This procedure is performed by a physician certified in anesthesia and pain medicine using live x-ray in either the office or surgery center setting. This procedure typically takes about 20 – 30 minutes and may be performed either with local anesthetic, oral sedation or IV sedation in the surgery center, depending on patient preference.
You will be taken back to an exam room and asked a series of questions and asked to sign several papers and/or consent forms. We will describe the procedure you are scheduled to undergo and what to expect.
You will be taken into the room where the procedure will be performed. Then you will be asked to either remove your shirt and change into a gown or undo your pants and lie on a table. An area of your skin will then be cleaned/sterilized, which may feel cold. You will then feel an injection with a small needle into your skin to numb the area. The procedure involves a special needle that is advanced to the target area under fluoroscopic (x-ray) guidance. A small amount of electrical current is used to identify proper placement along the targeted nerve. You will feel a buzz or tapping sensation, but it typically isn’t painful.
Once the needle has been properly placed, a local anesthetic will be placed into the targeted area. The radiofrequency ablation will then be performed, which typically lasts a few minutes. A combination of local anesthetic and steroids are then injected before the needle is removed.
You will return to the exam room. You will typically need to remain for 15 – 20 minutes to recover depending on the type of anesthetic used during the procedure.
What are my risks? What are common complications?
Pain management injections are extremely safe. However, all procedures have the possibility of complications such as bleeding, infection, allergic reactions and possible nerve injury. Another risk of an injection is a failure to improve, as there is no guarantee your pain will be relieved. Rarely, an injection may temporarily increase your pain.
You may experience flushing of the face or increased hunger, increased pressure at the injection site, muscle cramping or hiccups. Steroids may increase blood sugar and blood pressure for up to two weeks after the injection.
Most patients do not experience typical side effects such as weight gain, hair loss or abnormal hair growth from injections like those patients who take oral steroids.
What do I need to know before the procedure?
Ensure you know the location where you are to have your procedure. We have a procedure suite on the second floor of our Carmel office location as well as our Avon and Greenwood office locations, but we also perform procedures in a few ambulatory surgery centers in the Indianapolis area.
You must bring a driver with you to the procedure. This person will need to be able to drive you home and give you some assistance following the procedure. This is necessary for your safety as well as the safety of others. You could develop temporary numbness/weakness in your extremities following a rhizotomy.
You may take your regularly prescribed medications such as blood pressure, heart, diabetes and pain medications the day of your procedure.
If you take any blood thinners—for example Coumadin, aspirin, Plavix, Xeralto, Eliquis or Ticlid—make sure we are aware of this medication as soon as possible. You will be given specific instructions regarding any need to discontinue or modify your current use of any blood-thinning medication. If necessary, we will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you based on your heart history, including prior heart attack, stent placement or open-heart surgery.
Be sure to make us aware if you have been started on an antibiotic for a bacterial infection prior to arriving for your injection. This may cause your injection to be delayed until you have cleared the infection.
You may shower/bathe before your procedure.
You may eat a light meal before your procedure unless you have been scheduled for IV sedation at one of our surgery center locations. If you are to have sedation, you should not eat or drink anything after midnight the night before your procedure. This includes water, coffee, chewing gum and hard candies.
General discharge instructions
You could feel dizzy or unsteady when you stand up. This can be normal. Take your time by rising slowly from a seated or lying position.
You can have numbness in your arms or legs following the procedure. This can be normal and expected. Be careful getting out of a vehicle and make sure you can stand up before putting all of your weight on your legs. Do not drive until all of the numbness has worn off. This can last from an hour up to several hours.
You can shower/bathe following your procedure unless told otherwise.
After most procedures, you will be asked to take it easy over the next couple of days. You may need to be off work the remainder of the day. If you need a work note or release, please ask us and we will be glad to provide you with one.
A follow-up appointment will be scheduled after your procedure. If you have any questions or concerns regarding your procedure, please do not hesitate to contact your physician’s office.
What should I expect while recovering?
For the first few days, there may be an increase in the pain until the steroids take effect. It may take up to 30 days before the full effects of the radiofrequency procedure are realized. You can also develop a small area of numbness in the skin overlying your spine or dizziness if the procedure was performed in your cervical spine (neck).