Cervical Facet Joint Rhizotomy (RFA)
posted by : Dr. Barnetton: 23 February, 2019
This is a treatment for chronic facet joint pain. This is a clinical diagnosis of axial neck pain. Common causes of facet joint pain include arthritis, degenerative disease of the spine, and trauma. In the absence of injury or accident, the most common cause for facet mediated pain is degenerative disease of the spine or arthritis. Therefore, older patients are more commonly afflicted with facet joint pain. In whiplash injuries of the neck, commonly seen in motor vehicle accidents and other traumatic events, the cervical facet joints can be traumatized, and this can lead to chronic neck pain and headaches. The headaches are typically muscle compressive (tension) type, resulting in Occipital Neuralgia headache patterns. (see headache)
The facet joint is a synovial joint in the spine that is similar to the knee or hip joint in that it has a joint capsule, articular cartilage, a nerve supply, and can become painful. Facet joints are paired (one on each side) and are present from the top of the cervical spine in the neck all the way down and through the lumbar spine in the lower back. Historically injection therapy was injecting medication into the joint. RFA of the small nerve to the joint is now the standard in a chronic state.
The experience is not very unpleasant, it is outpatient, fast, and very efficient. Of course under X-ray it is extremely accurate and safe. Typically the neck treatment allows prolonged relief, reduction of pain medicines, more efficient use of P.T., and near immediate increased range of motion. There are very few side effects to this treatment. Cervical facet treatment in the neck can last from 6 months to a year. I isolate the nerve to the joint with a local anesthetic injection and if the patient gets the appropriate response, (80% benefit) for a period of time, I perform a Rhizotomy, creating a lesion on the nerve, (it always grows back) which can disconnect the joint, reducing the input from the pain source.