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Lumbar Radiofrequency Neurotomy for Chronic Low Back Pain

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Surgical Incision

What are lumbar facet joints?

Facet joints are found on both sides of the spine.  Each is about the size of a thumbnail.  The lumbar region of the spine contains five vertebrae and is located in the lower back.  Lumbar facet joints are named for the vertebrae they connect and the side of the spine where they are found.  The right L4-5 facet joint, for example, joins the 4th and 5th lumbar vertebrae on the right side.  Medial branch nerves are the nerves that transmit pain signals from the facet joints to the brain.

What is lumbar facet joint pain?

Lumbar facet joint pain is the result of joint dysfunction, either due to injury or irritation.  Pain from an irritated lumbar facet joint may range from simple muscle tension to more severe pain.  Depending on which facet joint is affected, the pain may occur in an area from the lower back into the buttocks and occasionally into the legs.

How do I know if I have lumbar facet pain?

If you have pain in one or more of these areas and it has lasted longer than a few months, you may have lumbar facet pain.

What is a lumbar radiofrequency neurotomy?

During this procedure, radiofrequency energy is used to disrupt function of a lumbar medial branch nerve, so that it can no longer transmit pain from the irritated joint.  This is a safe and very effective procedure for chronic pain stemming from the cervical facet joints.

What happens during an injection?

This procedure is normally done with intravenous sedation.  Sedation will require that you fast for four hours prior to the procedure.  If you will not be having sedation, we recommend that you eat a normal meal prior to the procedure.  A local anesthetic will be used to numb the skin.  The doctor will then insert a thin needle directly into the facet joint.  If at any point in time the procedure becomes painful, you should let the doctor know as he can use more anesthetic to numb the painful area.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will then check that the needle is in the proper position by stimulating the nerve.  This may cause muscle twitching.  When the needle is in the correct position, the area will be numbed.  Radiofrequency energy will then be used to disrupt the medial branch nerve.  This often feels warm or tingly, but should not be painful.  


What happens after an injection?

You will be monitored for approximately 30 minutes after the procedure.  Before you leave the clinic, you will be given discharge instructions.  Please keep track of your pain as this will help your doctor determine the next step in treatment.  It is normal to feel better immediately after the procedure.  This is the effect of the anesthetic.  It will most likely wear off a few hours after the procedure.  You may feel sore for a few days after the procedure.  This is normal and is caused by mild muscle or nerve irritation.  Full pain relief takes anywhere from two to four weeks.  You should be able to return to work the day after the procedure.

How long can I expect pain relief?

Nerves regenerate after a radiofrequency neurotomy procedure.  The typical duration of pain relief is 10-16 months.  If your pain returns at that time, the procedure can be repeated.

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