Facet Joint Rhizolysis

Back or neck pain may arise from a number of anatomical structures and one of these is commonly the facet joints. These joints are part of the mobile structure of the spine and therefore are prone to degenerative changes as part of the normal aging process of the spine. They may also be part of other inflammatory processes which affect joints such as in conditions such as arthritis and so may be a source of pain. These joints may be inflamed in conditions such as whiplash or after minor sporting injuries.

Pain from the facet joints will often settle without any intervention as the body’s natural healing action takes care of the inflammation and this may be aided by the use of anti-inflammatory medication and physical therapy offered by your physiotherapist or osteopath.

Facet joint injections of steroid may be useful when facet joint pain has not improved with these conservative measures. Please see www.spine-care.co.uk for additional information on this procedure.

What is Rhizolysis?

The facet joints are innervated by a small branch of nerves which carry pain impulses from the joints to the brain. These impulses may be blocked by the use of a local anaesthetic for a short period or for a longer period by coagulating the nerve with a radiofrequency wave. By placing a needle probe on the nerve a very specific and isolated area can be coagulated without having an effect on other structures in the area.

Rhizolysis is the process of cauterisation and is provided by the specialised machine that generates the radiofrequency pulse. The procedure itself is performed in a very similar way to facet joint injections and is performed using specialised needles placed percutaneously.

Am I suitable for Rhizolysis?

Mr Orpen will specifically assess whether you may be suitable to consider this procedure and usually will suggest trying facet joint injections and physiotherapy in the first instance before considering facet joint rhizolysis.

Should facet joint inejections only provide temporary improvement on two separate occasions, then rhizolysis may be considered as an alternative to repeated facet injections and will provide improvement in back or neck pain in 60-70% of patients for over a year while rehabilitation continues. The procedure can not be guaranteed to work but after a correct diagnostic work-up, is a relatively small procedure to be performed as an alternative to surgical intervention

Are there any risks?

The risks associated with the procedure are low and the machine itself performs a test to ensure no other nerves are cauterised other than specifically the pain sensing nerves from the facet joints. It is normal to have an increase in back pain for a couple of weeks after the procedure as the bruising settles and it may take up to six weeks to realise the full benefit.

The risk of infection or inadvertent nerve injury is low. The procedure can be repeated as in some patients even after a positive response the nerves regenerate and so pain may return. This may take some years. All procedures such as this, will have a reduced risk if performed by surgeons with experience and appropriate training in the technique.

Follow-up arrangements

An appointment should be made to see Mr Orpen in clinic two weeks after the procedure. Rhizolysis is performed as a day case under local anaesthetic. Arrangements should be made as it is not recommended to drive yourself home after any spinal procedures. You will not be required to take time off work and you may return to driving as soon as you are comfortable which is usually the following day.

It is recommended that you start physiotherapy as soon as you are comfortable. It is reasonable to remain on your regular pain medication for a few weeks after a rhizolysis procedure and Mr Orpen can advise on how to effectively reduce the dose of your medication at the two week visit following the procedure.