Facet Rhizotomy is a minimally invasive procedure that is performed for the treatment of back pain.  More specifically the procedure treats pain coming from the facet joint in the spine. 

Science/History:

The facet joint is an extremely important anatomical structure of the spine.  For detailed information please see the topic “facet joint” and refer to the drawing.  Briefly; the facet joints are paired structures in the back of the spine that carry spinal load and control the motion of the spinal segments.  Like most other joints (knee or elbow) they have cartilage and synovial fluid to allow the joint to function smoothly. 

As the degenerative process progresses the joint may become painful.  The pain signal is carried from the facet joint through a nerve branch to the spinal canal and up to the brain.  Facet Rhizotomy blocks this nerve from sending the pain message and therefore provides pain relief. 

 Facet Rhizotomy is generally done by performing a radiofrequency lesion that heats the nerve to make it nonfunctional.  This is done by placing a needle near the facet joint using x-ray guidance. The procedure can be done as an outpatient under mild intravenous anesthesia. The amount of relief obtained from this procedure can range from none to significant relief.

 A surgeon’s perspective:

This procedure is an essential part of the spinal neurosurgeon’s armamentarium.  The key is to determine which patient is an appropriate candidate.  The clinical acumen of the surgeon will allow the right patient to get access to the procedure and hopefully improve.  The procedure is very low risk and requires little recovery.  This makes the procedure attractive.  Benefit may only be maintained from 6 months to a year.  This may require the procedure to be repeated.

 At USC Spinal Neurosurgery we perform this procedure in conjunction with our pain management team.  Patients with the right clinical presentation who are at increased risk from open surgery may benefit dramatically.

 A patient’s perspective:

Many patients are attracted to this type of procedure because of the minimally invasive nature and the quick recovery.  However, Most patients have a multifactorial cause of their pain and the facet joint pain only constitutes a small component.  These patients may not be candidates for the procedure.  Facet cortisone injections may be useful in determining which patients are the best candidates