Linda,

I was given the option of Rhizotomy by Hopkins after my laminectomy failed. I went back to Penn and the docs at Penn told me they thought that was bad medicine for me...Hershey was also willing to try it. After I read about it I decided it was not for me...I will see if I can find some research about it as well...We did have some great infor on the old BT board.

Facet Rhizotomy
Steven Richeimer, M.D.
Director
USC Pain Management, USC Medical Center
Los Angeles, CA, USA

Ms. Mary Claire Walsh
SpineUniverse Staff Writer

http://www.spineuniverse.com/display...rticle200.html
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 flexible.






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, 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 may be the answer.

What is facet rhizotomy?
The goal of a 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 it 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 along side 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 released.

What to expect
Very little preparation is required for a facet rhizotomy procedure:

•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 the procedure.

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 following day.

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.

Serious complications are rare, however contact your physician if you experience any of the following:

•Prolonged pain at the injection site
• Fever
• Chills
• Dizziness
• Weakness
• Numbness that lasts more than 2-3 hours
• Bleeding or drainage at the injection site

Facet joint rhizotomy or medial branch neurotomy can effectively treat low back pain emanating from painful facet joints unresponsive to steroid injections. This efficacy hinges on the technical skill of the physician performing the procedure. Each facet joint is supplied by two small nerves so two needles must be placed to treat one joint. Findings of a recent surgical anatomical study have confirmed the accurate course of these nerves targeted in this procedure providing more compelling evidence for proper needle placement. Safe needle placement is critical in avoiding complications related to inadvertent injury to nearby structures leading to increased back or new leg pain. Although symptom reduction may be appreciated within a few days, facet joint rhizotomy should not be considered unsuccessful unless no pain relief occurs by 6 weeks after the procedure. Evidence shows that 60% of properly selected patients experience at least a 90% reduction of their low back pain that is sustained for 12 months, and 87% obtain at least 60% relief. If low back pain symptoms return over time, repeating the procedure can restore similar pain relief. However, one must keep in mind that these results are attainable when completed by well-trained interventional spine specialists experienced in executing these procedures.

GJZH I might be confused but it seems that there appears to be at least 3 names for what I believe is the same procedure?

RF Lesioning
RF Abalation
Rhizotomy

As I mentioned earlier in this thread, I was one of the unlucky ones to have complications after the procedure. It is over 5 months since my RF of C3/4 facet joints and I still have the numbness, neuralgia and new painful spots I did not have before the procedure. (Thanks to paritally hitting C2 nerve branch)

On my copy of the "Report of Operation" The technical name listed is: Radiofrequency rhizotomies Right C3/4 medial branches with fluoroscopic guidance. Yet, my Doctor first called in verball an RF Abalation and the written literature I was given describing the process it was called an RF Lesioning....

Jyes

http://www.cigna.com/health/provider...al%20nerves%22

Study done by ASIPP (American Association of Interventional Pain Physicians)

Study by pain physicans that demonstrates that RFA does work to stop pain for spinal patients. This particular study may be just a little biased since it was a study done by the very people who may stand to profit by the doing the procedure. JMO

I think they do this to confuse us, but...I think in the end they are trying to achieve the same goal, deaden the nerve, but they may go about in different ways.

Just as in the article they call it "Facet joint rhizotomy or medial branch neurotomy."

Neurotomy means the surgical severing of a nerve while Rhizotomy means resection of the dorsal root of a spinal nerve to relieve pain and sometimes to decrease spasms. Ablation is the amputation, excision of any part of the body, or the removal of ... This is all according to Mosby's Medical Dictionary...but then it depends how they are going to do this..


This procedure can be done using two different methods. I was offered both and both are deemed effective.

One method was described in the article I posted and the other is by cryoablation. During this procedure cold is used and is described here:


cryoneurolysis/cryoablation: a technique that relieves pain by using cold to destroy nerve tissue.


Radiofrequency nerve ablation is the term used when radio waves are generated and used to produce heat. By generating heat around a nerve, the nerves ability to transmit pain is destroyed, thus ablating the nerve.


Rhizotomy- surgical severance of spinal nerve roots to relieve pain or hypertension.

Severance can be performed by cryoneurolysis/cryoablation and radiofrequency nerve ablation. These are two methods of deadening the nerve tissue and stopping the pain. The nerve is severed during these procedures.

I think the argument on the forum (Braintalk1) (I feel like I am referring to a Dr. Seuss book) was that there is not enough evidence to support using this procedure on spinal patients. There are studies and they do support that pain does subside in some people. The problem with all of this is that these procedures were used on cancer patients and the cancer patients were terminally ill so correct me if I am wrong...we do not know the long term side effects of these procedures because unfortunately the cancer patients died. The one side effect with all of this is that the nerves grow back. When they do, you tend to have more pain because the nerves look much like the branch of a tree because they have been severed..You can go through the procedure again in hopes of finding relief. ..I hope I am explaining this correctly...and if not someone please feel inclined to correct me...I will not be angry...and if Doc W is around...someone please have him explain the pros and cons...He knows better than any of us...

I just decided that this was not for me...My OSS at Pennsylvania Hospital did my cervical fusion. He thought this procedure would not help me...I asked my pain management doctor and he nixed it as well...That was two docs, so I respectfully declined the procedure and went for surgery...The spinal blocks did not work for me either...

You know the problem with google is that the big drug companies and doctors can pay to have their websites right at the top, so when you do a search to try to determine if this procedure might not be right for you...What do you find...? One advertisement after the other for the procedure ...A website setup for a pain management doctor...Is this what google was originally intended to be? A gigantic advertisment forum for the rich? Is this objective or subjective...I mean I googled problems with rhizotomy and only one page popped up and that was Patrick's page..and Patrick is angry so I do not know if he is being objective either...and some of his information is incorrect....

http://home.inreach.com/doodle/shtml/neurolysis.htm

Also, there has got to be more than one guy with problems from this procedure. I remember on BT that a woman had some nerves severed by mistake and she had trouble walking for awhile, didn't she? Does anyone else remember? Wasn't it on BT?

We have to remember that just because it is on the Internet does not mean it is correct either....I quoted the Hand University Website to my hand surgeon last week and the information at the website was old and wrong...so you have to be careful and fully research every thing...

Hi G~
This was the exact way my Anesthesiologist explained it to me as to why he and my Physiatrist decided against the procedure. They opted for the injections because of my age. Again, this is just my experience.

Hugs,
Jan

I am not sure if this is related to my procedure or not, but I had the strangest thing happen to me this morning. I know that if I could see everyone, I would never tell this. I woke later than usual this morning and knew that I had to go get some blood work done. So I was laying in bed thinking about getting up, when I had this strange feeling. My (girl thing between my legs) was spasming. I had 3huge orgasms!!! I don't know if it was related, but it was not bad. -Linda

Just found this page, Googling RFA. I agree with the people that feel Google is an advertisement media for the rich. All the info I've read thus far has, hands-down sided with the procedure (cleverly disguised as a non-biased informational source). Then I find this forum full of sceptics. Instantly changing my view. It feels far more honest here.
I am suffering from a Facet Joint problem, C2/3 - C3/4, resulting from my head smashing into the window frame of the windshield on a Geo Metro, at 60 miles an hour. My multitude of doctors over the last two-and-a-half years have labelled it, a compression fracture, myofacial, or"whiplash"(not even a medical term, and Webster's definition isn't even consistent with my case, but doctors still, after I bring this to their attention, use the term).
I have tried ciropractic care with no help. Accupuncture is quite helpfull as well is Physical Therapy. I have already had two set of facet joint injections. Both with great improvement of my pain, and range of motion. I believe these were to pinpoint the nerve, so the RFA could be administerred. I'm this far now and affraid of "frying", or "severing" any amount of nerve tissue in such a sensative area. Seems like the risk is too great. Who knows what these scarred, mutilated nerve endings will do in 20 years.
Any additional info. on the Cryoneurolysis/Cryoablation, or Pulsed RFA would be appreciated. Thanks you all. J-Moe

Hi, great forum. I have been suffering with osteoarthritis for several years and over the past 18 months things have gotten progressively worse. I have cervicogenic headaches that keep me non-functional for days. Have had facet joint injections in c-spine worked for about a month and wham back to the headaches. They sent me to PT for 16 weeks at 3xs a week, that's 58 sessions, cost me $580.00 in co-pays. They worked on stuff that I did not even have nor did I complain about; shoulder impingement, they wasted 4 weeks on that one. PT helped for my low back pain for a while. But when they started on my neck it became a misery, extensions, retractions and the last straw was when they put me in c-cpine traction on two occassions, elicited extremely brutal headaches.
So I moved onto pain management where they started with the facet joint injections in c-spine, that worked for about a month. Headaches have now returned and I cannot function with them. Spoke to my neuro today and he is recommending RFA. I have read a lot about it and understand the possible side effects and the mistakes that can be made but anything has got to be better than these headaches. I have considered paying out of pocket for botox injections in the nerves actually until I made that statement to the neuro he had only perscribed NSAIDs and PT for the pain.

For anyone who doesn't know facet joint injections are diagnostic as well as therapeutic in nature, if they work then they know the cause of the pain is the nerve at the facet joint if they do not work then that is not the source of pain. The local that is injected wears off in several hours and the steroid they inject can take several days to kick in for the full effect, so if the injections do not provide any relief than your source of pain more than likely is not the nerves at the facet joints. If the injections are not effective they will not follow with RFA, there is no point to it, it won't work.

Oh, the physiotherapist called and left a message "I don't understand why your doctor has not responded to the patient note I sent and the request to continue PT for you." "Give me a call and we will see about getting you back for more PT". This guy didn't want me to have the epidurals in the first place he wanted to extend PT for yet another 8 grueling weeks or longer.

Here's one you will all appreciate: Spoke to neuro this afternoon as PM is on vacation. He has perscribed Tramadol for my head and worsening back pain and on Monday I should make appt. with PM for RFA. I take 20 to 30 mg of Elavil at bedtime for sleep and some pain (from my GP). I ask neuro if the Tramadol can be taken with Elavil, he says sure no problem, I ask pharmacist when I pick up Tramadol if there is a problem with that and Elavil, she says no problem. I read the drug sheet provided by the pharmacist and low and behold YOU CANNOT TAKE TRAMADOL AND ELAVIL TOGETHER can cause seizures and other pretty major problems. Now what do I do, if I stop the Elavil I will go through withdrawl, but the pain is pretty intense so I opted to take the Tramadol this evening and tomorrow morning, if my headache and backache are improved I will need to take at least 10 mg of Elavil. Honestly you can't trust any body with your health these days!

Sharon

My Test Results
MRI C-SPINE
Multi-level spondylosis most marked at C4-5 with right foraminal stenosis by osteophytes. Advance spondylitic narrowing of the C4-5 interspace with anterior and posterior spurring. Foraminal encroachement by osteophytes. Mild narrowing of C5-6 and C6-7 interspaces with mild spurring. Osteophyte on the right at C4-5 attenuates the ventral aspect of the thecal sac but cause no mass-effect upon the cord.

MRI L-SPINE
(Minor Grade I, 5% anterolisthesis of L4 on L5 due to severely degenerated facet joints. Marrow changes at L2-3 reflect DD change. T12-L1 mild DD changes with disc bulge. L1-2 is normal. L2-3 moderate DD and facet changes with disc bulge. L3-4 mild facet degenerative changes. L4-5 mild to moderate dd and moderate degenerative facet changes with left side disc bulge. Mild left lateral recess and left more than right foraminal stenosis. L5-S1 mild to moderate facet degenerative changes.) **This one done in 2006, the one done in 2004 shows the disc at L4-5 "small herniation to the left of midline". They claim the MD in 2004 was probably not well trained in reviewing spinal MRI.

Xray of T-Spine: Degenerative changes fo the thoracic spine, no evidence of fracture of subluxation. (Suppose I should have an MRI done for the T as well)

Glad to see some more action in this forum. I've decided against the RFA. I'm glad the first injections were succesful in pinpointing the pain, but now am trying to research any other options. My doctor completely blew me off and denied any further help once I decided against the procedure. I really felt abandonned. I don't like health care people too well right now.
Any suggestions on other treatments would be greatly appreciated.
Be careful with those drugs Sharon. Some of these doctors really don't have a damn clue, or give a damn, I think. J-moe

Also my doctor denied that the RFA actually cuts or burns or severs the nerve. Complete oposite of everything else I researched. He also made his nurse explain all of this to me, and would not talk to me.(He makes me so mad) Because I'm not going through with this multi-thousand dollar treatment that will indefinately need repeating, thus giving job security to this a#$hole, he is completely and cold-heartedly denying any form of guidance other than this procedure.