NOTE: THESE PROCEDURES OR INJECTIONS SHOULD ONLY BE ADMINISTERED BY AN MD OR DO TRAINED IN INTERVENTIONAL PAIN MEDICINE
Medial Branch Radiofrequency Neurotomy to the Z-Joints (Facets)
WHAT IS RADIOFREQUENCY NEUROTOMY OF THE Z-JOINT (FACET) MEDIAL BRANCH NERVES?
The Z-joints joints are located in the back of the spine and prevent excessive twisting of the spine. If it has been determined through a medial branch nerve injection (diagnostic) that the pain is emanating from the joint, then radiofrequency neurotomy (therapeutic) of the small nerve going to the joint may be employed for longer acting pain relief from pain due to arthritis or joint damage to the neck or low back. The radiofrequency current causes an interruption in nerve transmission of pain that can last up to18months, but is usually less. After needle placement, you may be asked questions during the procedure about any mild electrical signals you feel or if you experience any other sensation.
DOES THE RADIOFREQUENCY HURT?
After the needles are placed, local anesthetic is injected before the radiofrequency is activated. Most patients tolerate the procedure well, although some physicians will elect to incorporate sedation in selected situations.
If no sedation is scheduled, you may eat and drink normally on the day of the procedure. If sedation is to be used, then you should have nothing to eat or drink after midnight on day of the procedure except for the daily medications, withholding those listed below. If sedation is scheduled, then you will need a driver afterwards. .
MEDICATIONS TO STOP BEFORE THE PROCEDURE:
- Stop Plavix 7 days before the procedure.
- Stop coumadin and warfarin 5 days before the procedure.
- Stop Ticlid (ticlopidine) 14 days before the procedure.
Bleeding, infection, abscess, nerve injury, spinal injury, spinal headache are all very rare. However dysesthesia (burning like pain in the low back, buttock, and thigh) is not uncommon, but this side effect is temporary.
AFTER THE PROCEDURE:
You will be in our Center for about 20-30minutes after the procedure and should be able to drink juices and have a clear head before discharge without any leg weakness or significant numbness. However, occasionally one might experience some temporary leg numbness due to the anesthetic injected during the procedure, therefore the patient should have assistance available if needed to walk during the first several hours, and should not attempt to drive the same day.
- Activity: Resume normal gradually over a few days.
- Diet: Resume normal diet
- Medications: Resume normal medications unless otherwise instructed. If you are given a new prescription for narcotic pain medications, take as directed and remember pain medications may require 45 minutes to reach their peak effect. Pain medications may make you dizzy or drowsy.
- Dressing: You may have a small bandaid or bandaids placed over the injection site. This can be removed the next day
- Discomfort at the Injection Site: Apply ice wrapped in a washcloth for short periods of time (20 minutes per hour) during the first 24 hours, then apply low to medium heat
- IV Site: There may be soreness and bruising around the IV site, if you have one, which will go away in a few days. A warm moist cloth placed over the area for half-hour periods several times a day will sometimes help. Increased tenderness or red streaking around the area of the IV site or increasing swelling of the hand requires attention. Our Center needs to be notified if this occurs
- Side Effects: Possible side effects of local anesthetics used include numbness of the leg or arms. Let us know if this occurs. If you experience new onset severe generalized weakness during the first week after the injection, call our office. If you develop fever of more than 102 degrees during the first few days after the injection or severe increase in pain in the back or neck, notify our office. Occasionally, patients may require neurontin or lidocaine cream to help with burning pain after the procedure. Call our office if you develop this side effect.
- Return to Normal Activities: You may experience some numbness in the skin over the back during the first several hours and numbness in the thigh for a period. There may be temporary numbness in the leg or foot up to 12 hours however notify us immediately if this occurs and the physician was not aware of this at the time of your discharge.
- Anesthetic Effects: If you have sedation, refrain from operating motor vehicles within the first 12 hours after the injection, do not plan to make any important decisions such as signing legal or important papers within the first 24 hours after the injection, and do not consume alcohol or sedatives within 24 hours after the injection.