Radio Frequency Lesioning – Facet Joints
What is Radio Frequency Lesioning?
This is a procedure that uses a machine (Radio frequency generator) to generate a current to interrupt nerve conduction on a semi-permanent basis. The radio frequency current heats the surrounding tissue around a terminal branch of the nerve and this diminishes transmission of painful sensations. Radio frequency is a widely used method for lesioning nervous tissue. With this technique, a high frequency current is passed down an electrode, through a cannula that is fully insulated except for its tip. This heats the surrounding tissue from between 42-80°C and prevents the transmission of pain signals from the area being treated. This procedure can achieve 60 - 90% pain relief in many patients for periods of more than a year.
What are Facet Joints?
Facet joints (zygapophyseal joints) are located in the back of the spine. The facet joints are made up of two facing surfaces from the vertebra above and below. They stabilise the spine and limit extension and rotation of the spine. There are two joints one on each side of the spine at every vertebrae from L5-C1, each of these have two articulating (moving) surfaces; one surface faces upwards and the other downwards. The facet joints are surrounded by a capsule of connective tissue and contain a small amount of fluid, which lubricates the joints. The surfaces of the facet joints are coated with cartilage that allows the joints to move smoothly against each other.
Where and how is the procedure performed?
The procedure will take place in an x-ray theatre, to enable your doctor to place the radio frequency needles at the appropriate level for your pain. Nerves cannot be visualised by x-ray; the bones around the area of the nerves are used as landmarks and can be easily seen with x-ray.
A nurse or radiographer will take you into the theatre where the doctor will explain the procedure for you and ask you to sign a consent form. Please keep your glasses, if needed and bag with you. When you have signed the consent form the doctor will insert a canula, probably in your hand, in order to access your vein. This will enable the nurse to give sedation if required for the procedure.
You will be asked to lie down on the x-ray table, on your front for lumbar (low back) facet joint denervation or on your back for cervical (neck) facet joint denervation. A nurse will be with you at all times and you will be able to talk to her about any aspects of the procedure as it progresses. You will be offered sedation during the procedure. The sedation used is a combination of two drugs, which act in different ways. Fentanyl is used for pain relief and midazolam is a sedative used to help you relax. The amount of sedation you require will depend on how well you tolerate the procedure. You will need to be awake enough to communicate with the doctor and nurses.
How is the procedure performed?
The doctor will place needles in your back or neck under x-ray control and the radio frequency lesioning will take place at different levels. Once the needles are in the correct position the tissues surrounding the needle tip are heated using the Radio Frequency machine, this usually takes 60 seconds for each level. You need to be awake enough to report what you are feeling. The procedure takes about half an hour. During this time the nurse will be monitoring your heart rate, blood pressure and oxygen saturation. You may require oxygen by a facemask during the procedure.
What happens after the procedure?
You will be taken back to your recovery area where a nurse will monitor your progress and you will be able to rest for 30 minutes to an hour. You will then be offered something to eat or drink prior to getting up. Most patients are ready to go home an hour after the procedure is completed. You will not be able to drive yourself due to the sedation. It is advisable to take things easy on the day of the procedure. You may find that you experience some muscle soreness for up to a week after the procedure and it is expected that you will experience a reduction in your pain after this time. It can take about 3 weeks to experience the maximum pain relief, especially if there is a muscle pain component to the pain (this may need to be treated, in addition).
When should I go back to work after the procedure?
You should be able to return to work the next day. If you are experiencing some pain around the injection sites you may wish to take a further day or two off work or at least ensure that your workload is not too heavy.
If you have any further questions or anxieties relating to the procedure please do not hesitate to ask any of the staff in the Pain Clinic. Direct phone line 01798 831800.