Skip to main content Accessibility help
×
Home

Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value

  • Wen-Ching Tzaan (a1) and Ronald R. Tasker (a2)

Abstract:

Background:

There have been many reports of percutaneous radiofrequency facet rhizotomy, perhaps better referred to as facet denervation, usually performed under general anaesthesia, with inconsistent success rates.

Objectives:

To report the authors' outcome data using both general and local anaesthesia and to reassess the value of this controversial procedure.

Methods:

Our experience with 118 consecutive percutaneous radiofrequency facet rhizotomies performed on 90 patients in the Toronto Western Hospital was analyzed. Sixty percent of the procedures were performed under general anaesthesia, 40% under local anaesthesia. All patients had been temporarily virtually relieved of pain after local anaesthetic blockade of the subject facets by an independent radiologist.

Results:

The patients were monitored from 1 - 33 (mean 5.6) months after surgery, with complete elimination or a greater than 50% subjective reduction of pain considered the criteria for success. For the first or only procedure this was 41% overall, 37% in cases done under local anaesthesia, 46% in cases done under general anaesthesia (difference not statistically significant p=0.52). There was no statistically significant difference in success rates for procedures performed in the cervical, thoracic or lumbosacral facets, with unilateral versus bilateral denervations, when two to three as compared with more than three facets were denervated, nor for operations done in patients who had had previous spinal surgery compared with those who had not. Results were not better regardless of whether hyperextension of the spine aggravated the patient's preoperative pain or not, and when the procedures were repeated in the same patient outcomes tended to be consistent, arguing against repetition of failed facet denervations. The morbidity was low, the chief problem being sensory loss and transient neuropathic pain in the distribution of cutaneous branches of posterior rami in the cervical and thoracic areas; mortality was zero.

Conclusions:

Percutaneous radiofrequency facet denervation is simple and safe, still worth considering in patients with disabling spinal pain that fails to respond to conservative treatment. The use of general anaesthesia shortens the operating time and the patient's discomfort without impairing success rate.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value
      Available formats
      ×

Copyright

Corresponding author

Department of Neurosurgery, Chang Gung Memorial Hospital, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan.

References

Hide All
1. Goldthwait, JE. The lumbosacral articulation. An explanation of many cases of “lumbago, sciatica, and paraplegia”. Boston Med Surg J 1911; 164:356372.
2. Putti, V. New conceptions in the pathogenesis of sciatic pain. Lancet 1927; 2: 5360.
3. Ghormley, RK. Low back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA 1933; 101:17731777.
4. Badgley, CE. The articular facets in relationship to low back pain and sciatic radiation. J Bone Joint Surg Am 1941; 23: 481496.
5. Rees, WES. Multiple bilateral subcutaneous rhizolysis of segmental nerves in the treatment of the intervertebral disc syndrome. Ann Gen Pract 1971; 26:126127.
6. Shealy, CN. The role of the spinal facets in back and sciatic pain. Headache 1974; 14:101104.
7. Shealy, CN. Percutaneous radiofrequency denervation of spinal facets: treatment for chronic back pain and sciatica. J Neurosurg 1975; 43:448451.
8. Shealy, CN. Facet denervation in the management of back and sciatic pain. Clin Orthop 1976; 115:157164.
9. Babur, H. Facet rhizotomy for cervical radiculitis. Mt Sinai J Med 1994; 61:265271.
10. Banerjee, T, Pittman, HH. Facet rhizotomy: another armamentarium for treatment of low backache. NCMJ 1976; 37:354360.
11. Bogduk, N, Long, DM. Percutaneous lumbar medial branch neurotomy: a modification of facet denervation. Spine 1980; 5:193200.
12. Bogduk, N, Macintoch, J, Marsland, A. Technical limitations to the efficacy of radiofrequency neurotomy for spinal pain. Neurosurgery 1987; 20:529535.
13. Burton, C. Percutaneous radiofrequency facet denervation. Appl Neurophysiol 1976; 39:8086.
14. Florez, G, Eiras, J, Ucar, S. Percutaneous rhizotomy of the articular nerve of Luschka for low back and sciatic pain. Acta Neurochir (suppl) 1977; 24:6771.
15. Florez, G, Eiras, J, Ucar, S. Radiofrequncy facet denervation in the treatment of persistent headache associated with chronic neck pain. J Neurol Orthop Surg 1980;1:127130.
16. King, JS. Randomized trial of the Rees and Shealy methods for the treatment of low back pain. In: Morley, TP ed: Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976: 8994.
17. Lord, SM, Barnsley, L, Bogduk, N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Neurosurgery 1995;36:732739.
18. Lord, M, Barnsley, L, Wallis, BJ, McDonald, GJ, Bogduk, N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:17211726.
19. McCulloch, JA. Percutaneous radiofrequency lumbar rhizolysis (rhizotomy). Appl Neurophysiol 1976; 39:8796.
20. McCulloch, JA, Organ, LW. Percutaneous radiofrequency lumbar rhizolysis. CMAJ 1977; 116:3032.
21. Mehta, M, Sluijter, ME. The treatment of chronic back pain: a preliminary survey of the effect of radiofrequency denervation of the posterior vertebral joints. Anaesthesia 1979; 34:768775.
22. Ogsbury, JS, Simon, RH, Lehman, RAW. Facet “denervation” in the treatment of low back syndrome. Pain 1977; 3:257263.
23. Oudenhoven, RC. Articular rhizotomy. Surg Neurol 1974; 2:275278.
24. Pawl, RP. Results in the treatment of low back syndrome from sensory neurolysis of the lumbar facets (facet rhizotomy) by thermal coagulation. Proc Inst Med Chic 1974; 30:151152.
25. Rashbaum, RF. Radiofrequency facet denervation: a treatment alternative in refractory low back pain with or without leg pain. Orthop Clin North Am 1983; 14:569575.
26. Schaerer, JP. Radiofrequency facet rhizotomy in the treatment of chronic neck and low back pain. Int Surg 1978; 63:5359.
27. Schaerer, JP. Treatment of prolonged neck pain by radiofrequency facet rhizotomy. J Neurol Orthop Med Surg 1988;9:7476.
28. Silvers, HR. Lumbar percutaneous facet rhizotomy. Spine 1990; 15:3640.
29. Vervest, ACM, Stoler, RJ. The treatment of cervical pain syndromes with radiofrequency procedures. Pain Clin 1991;4:103112.
30. Auteroche, P. Innervation of the zygapophysial joints of the lumbar spine. Anatl Clin 1983; 5:1728.
31. Bogduk, N, Long, DM. The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low back pain. J Neurosurg 1979; 51:172177.
32. Bogduk, N. The clinical anatomy of the cervical dorsal rami. Spine 1982; 7:319330.
33. Bogduk, N, Wilson, AS, Tynan, W. The human lumbar dorsal rami. J Anat 1982; 134:383397.
34. Edgar, MA, Ghadially, JA. Innervation of the lumbar spine. Clin Orthop 1976; 115:3541.
35. Groen, GJ, Baljet, B, Drukker, J. Nerves and nerve plexuses of the human vertebral column. Am J Anat 1990; 188:282296.
36. Lewin, T, Moffett, B, Viidik, A. The morphology of the lumbar synovial intervertebral joints. Acta Morphol Neerl Scand 1962; 4:299319.
37. Pedersen, HE, Blunck, CFJ, Gardner, E. The anatomy of lumbar posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves) with an experimental study of their function. J Bone Joint Surg Am 1956; 38:377391.
38. Mooney, V. Facet syndrome. In: Weinstein, JN, Wiesel, SW eds. The Lumbar Spine: The International Society for the Study of the Lumbar Spine. Philadelphia: WB Saunders, 1990: 422441
39. Bradley, KC. The anatomy of backache. Aust NZ J Surg 1974; 44:227232.
40. Fox, JL, Rizzoli, HV. Identification of radiologic coordinates for the posterior articular nerve of Luschka in the lumbar spine. Surg Neurol 1973; 1:343346.
41. Bogduk, N, Marsland, A. The cervical zygapophysial joints as a source of neck pain. Spine 1988; 13:610617.
42. Donovan, WH, Dwyer, AP, White, BW, et al. A multidisciplinary approach to chronic low-back pain in western Australia. Spine 1981; 6:591597.
43. Lilius, G, Laasonen, EM, Myllynen, P, Harilainen, A, Groniund, G. Lumbar facet joint syndrome: a randomised clinical trial. J Bone Joint Surg Br 1989; 71:681684.
44. Mehta, M, Parry, CB. Mechanical back pain and the facet joint syndrome. Disabil Rehabil 1994; 16:212.
45. Mooney, V, Robertson, J. The facet syndrome. Clin Orthop 1976; 115:149156.
46. Snewing, G. Facet joint syndrome: a review. Physiotherapy Canada 1984; 36:141144.
47. Wetzel, FT. Chronic benign cervical pain syndrome: surgical considerations. Spine 1992; 17:S367–S374.
48. Lord, SM, Barnsley, L, Bogduk, N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophyseal joint pain: a caution. Neurosurgery 1995;36: 732739.
49. Lippitt, AB. The facet joint and its role in spine pain: management with facet joint injections. Spine 1984; 9:746750.
50. Lord, SM, Barnsley, L, Bogduk, N. The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain 1995;11:208213.
51. Marks, RC, Houston, T, Thulbourne, T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain 1992; 49:325328.
52. Revel, ME, Listrat, VM, Chevalier, XJ, et al. Facet joint block for low back pain: identifying predictors of a good response. Arch Phys Med Rehabil 1992; 73:824828.
53. Stolker, RJ, Vervest, ACM, Groen, GJ. The management of chronic spinal pain by blockades: a review. Pain 1994; 58:120.
54. Wood, L. Acute locked facet syndrome and its treatment by manipulation under local periarticular anaesthesia: Part 1. Clinical perspective and pilot study proposal. J Manipulative Physiol Ther 1984; 7:211217.
55. Barnsley, L, Lord, S, Wallis, B, Bogduk, N. False-positive rates of cervical zygaphophyseal joint blocks. Clin J Pain 1993;9:124130.
56. Lord, SM, Barnsley, L, Wallis, BJ, McDonald, GJ, Bogduk, N. Percutaneous radio-frequency neurotomy for chronic cervical zygaphophyseal-joint pain. N Engl J Med 1996;335:17211726.

Related content

Powered by UNSILO

Percutaneous Radiofrequency Facet Rhizotomy – Experience with 118 Procedures and Reappraisal of its Value

  • Wen-Ching Tzaan (a1) and Ronald R. Tasker (a2)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.