Cervical Facet Neurotomy

Cervical Facet Radiofrequency Neurotomy

There are a number of factors that have been associated with cervical pain that arises in the neck and upper back region. In fact, previous estimates have suggested that more than two-thirds of adults can expect to have some form of neck or back pain during their lifetime. In most cases, direct trauma or injury, muscle strain, pinched nerve, or even a herniated or slipped intervertebral disc can cause pain in the cervical region.

Several treatments are available and most are regarded as non-surgical and minimally invasive. One of these treatment options is cervical facet radiofrequency neurotomy. In fact, radiofrequency neurotomy of the cervical facet joint is regarded as one of the most commonly employed treatments for pain that arises from the cervical facet joint.

Previous studies have supported cervical facet radiofrequency neurotomy as effective in reducing the severity or even eliminating neuropathic pain. Studies examining the long-term effects of this treatment have revealed that patients report being free from debilitating symptoms of pain and discomfort for 15 months or more. Additionally, half of the patients examined in these studies reported being free from symptoms for two years.

What is Cervical Facet Radiofrequency Neurotomy

How Cervical Facet Radiofrequency Neurotomy is Performed

The facet joints of the body are located on the posterior sides of the spinal column. Most of the facet joints within the body have a decreased range of motion given their shape. Facet joints that are found in the neck and upper back area are known as cervical facet joints. Cervical facet joints have a somewhat different shape and, therefore, have a broader range of motion. When the structures of these joints become damaged or injured, the result is inflammation, joint stiffness, soreness, and even pain. Generally, these symptoms are limited to the neck and upper back area.

Within the nervous system, the spinal cord is the primary pathway by which information travels from the peripheral areas of the body to the brain. Given its crucial role in overall bodily function, the spinal cord must remain highly protected. Thus, it is surrounded by a durable membrane that is also surrounded by a bony structure known as the spinal column. Branching off of the spinal cord are medial nerves that transmit sensory information and provide muscle control to the facet joints.

Though the exact function of cervical facet radiofrequency neurotomy is not fully understood, it is believed to be effective in decreasing cervical facet joint pain by inhibiting the function of the medial nerves.

The procedure is regarded as relatively safe. It can be conducted on an outpatient basis and, typically, only requires the use of a local anesthetic.

In some instances, the patient may request the use of intravenous medication in order to make the procedure more comfortable.

Using an X-ray imaging device as a guide, the performing physician will insert a cannula (i.e., a small needle-sized tube) to the area of the affected nerve. The physician will then feed a small electrode into the cannula. Before performing the neurotomy, the physician must check the placement of the electrode. To do so, the performing physician will run a very low current through the electrode. This will trigger temporary pain signals and muscle contractions. Once the physician has confirmed the placement, a numbing agent is applied to the nerve tissue. Next, the physician will deliver a high level of heat to the area. The application of heat is used to create a lesion. This damage then inhibits the function of this nerve, thereby preventing the transmission of pain information to the spinal cord and brain

Conditions Related to Cervical Facet Radiofrequency Neurotomy

In general, cervical facet radiofrequency neurotomy is used to treat symptoms of pain and discomfort associated with conditions affecting the facet joint. The goal is to provide patients with relief from pain, but not all patients will respond to the procedure in the same way. Thus, it is important to talk to your doctor about cervical facet radiofrequency neurotomy and whether this procedure is appropriate for managing your particular symptoms of pain.

Some studies have supported the use of cervical facet radiofrequency neurotomy in treating the pain and discomfort associated with whiplash. Other common conditions that are treated with cervical facet radiofrequency neurotomy include:

Pain in the upper back
Pain that worsens upon twisting or lifting something heavy
Pain that improves when lying down

Conclusions

Cervical facet radiofrequency neurotomy is an effective treatment for managing the pain and discomfort associated with neuropathy in the cervical region. This treatment is regarded as non-invasive, is done on an outpatient basis, and is typically considered after other techniques have failed to provide relief from symptoms. The aim of this treatment is to inhibit the transmission of pain information within the cervical facet joint areas. Patients who are considering this procedure are encouraged to speak to their doctors about the risks and benefits associated with cervical facet radiofrequency neurotomy.

References

Cohen SP, Husang JH, Brummett C. Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101-16.
Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Leg Med. 2013;20(2):74-85.
Falco FJ, Datta S, Manchikanti L, Sehgal N, Geffert S, Singh V, Smith HS, Boswell MV. An updated review of the diagnostic utility of cervical facet joint injections. Pain Physician. 2012;15(6):E807-38.
Falco FJ, Manchikanti L, Datta S, Wargo BW, Geffert S, Bryce DA, Atluri S, Singh V, Benyamin RM, Sehgal N, Ward SP, Helm S, Gupta S, Boswell MV. Systematic review of the therapeutic effectiveness of cervical facet joint interventions: An update. Pain Physician. 2012;15(6):E839-68. Review.
Husted DS, Orton D, Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain. J of Spinal Disorders & Techniques. 2008;21(6):406-408.
Mukai A, Kancherla V. Interventional procedures for cervical pain. Phys Med Rehabil Clin N Am. 2011;22(3):539-49.
Van Eerd M, de Meij N, Dortangs E, Kessels A, can Zundert J, Lataster A, Patijn J, van Kleef M. Long-term follow-up of cervical facet medial branch radiofrequency treatment with the single posterior-lateral approach: An exploratory study. Pain Pract. 2013;18

Once the procedure is performed, patients are monitored closely for the possibility of adverse side effects. In most instances, patients are advised to arrange for a ride home following the procedure. Additionally, patients must use caution before returning to typical daily activities. For instance, many patients will report experiencing muscle weakness and even soreness in the area following a cervical facet radiofrequency neurotomy procedure.

In most instances, damaged medial nerves can take up a month to completely atrophy. During this time it is not uncommon for patients to report ongoing complaints of muscle soreness and weakness. Some patients may wish to talk to their doctor about possible medications that may be used temporarily to manage these symptoms of pain.

As with many other medical procedures, there is some risk to patients who are considering cervical facet radiofrequency neurotomy. These risks are regarded as relatively rare and include:

Pain or discomfort in the area of the injection
Numbing in the area of skin above the treated area
Muscle spasms
Allergic reactions to the medication
Infection
Permanent nerve damage and pain