FACET BLOCK & RF RHIZOTOMY
The cause of back pain can be the small joints of the back called facet joints. Just like large joints (like knees, shoulders and hip) are well known to be affected by arthritis as we grow old, unfit and overweight similarly the small joints of the spine are also affected. This is a major source of pain and can be treated without need for open surgery and can make a bed ridden person walk pain free. Surgery can be avoided or delayed by this method of pain relief and appropriate life style modifications.
Facet joint is an important pain generator in this group of patients and treatment using radiofrequency ablation is a minimally invasive treatment option.
A facet block, using local anesthetic with steroid usually has two goals: to help diagnose the cause and location of the pain and also to provide pain relief.
Radiofrequency (RF) rhizotomy or neurotomy is a therapeutic procedure designed to decrease and/or eliminate nerve pain for a longer period, usually 2 years.
321 patients with chronic back pain treated in our unit between 2007 and 2017 of which 206 have had radiofrequency rhizotomy treatment for facet and S.I related back pain.
A 39 years old male who had low back pain for 10 years, was treated conservatively initially, and then twice received epidural injections of steroids with no relief. He then underwent discography (where a contrast material is injected into the disc suspected to be the source of pain as a provocative test) that confirmed that the source of his back pain was his degenerated disc at L4-5. He underwent a single level lumbar disc replacement and is now symptom free 5 years later.
MRI showing the hypertrophied facet joints
Intra-operative X-Ray showing the facet joints and site of injection if block is to be given in the joint.
Alternatively the median nerve branch supplying the facet joint can be blocked producing the same effect.
CASE STUDY - RF RHIZOTOMY
A 67 yrs, old female presented with complaints of back pain for 3 years with some leg pain radiation and was unable to walk due to pain. Her pain increased on walking and in supine position. After the procedure she has remained pain free at two year follow up.
Procedure -Trial of L2 to L5 dorsal rami block and S.I. joint block followed by L2 to S1 dorsal rami RF rhizotomy.
CT scan of the patient with back pain of facetal origin showing
marked facetal hypertrophy at L4-L5 and L5- S1.
Patient undergoing RF procedure under X-ray