Medial Branch Neurotomy

What is a medial branch neurotomy and why is it helpful?
A medial branch neurotomy is a non-surgical procedure which cauterizes the nerves (through very localized heating) that allow you to feel pain caused by your facet joints. Your facet has been proven to be painful by diagnostic injection procedures, but your pain has not been reduced by other treatment methods. Likely, we have previously numbed the medial branch nerves to see if you were a candidate for the neurotomy. The pain relief you obtained from numbing the facet nerve supply (medial branch nerves) should persist for several months after locally heating
(cauterizing) these nerves.

In some patients, the pain never returns. The neurotomy (if technically successful) theoretically prevents the pain signal from traveling through these nerves (from your joints to your brain) so you cannot feel or sense your injured and/or diseased spinal joints. These medial branch nerves do not control any muscles or sensation in your arms or legs. They only allow you to feel these joints and small nearby ligaments and control a short, small muscle (multifidus muscle) in your neck, mid-back or low back. Studies have shown that there is no functional or clinical significance from ablating the multifidi muscles.

What happens during the procedure?
Lying on your stomach, the skin over your neck, mid-back or low back will be well cleaned. The physician will numb a small area of skin with numbing medicine which may sting for a few seconds. The physician will use X-ray guidance to direct a special (radiofrequency) needle along side the targeted medial branch nerve. A small amount of electrical current will be carefully given through the tip of the radiofrequency needle to assure the needle is precisely next to the target medial branch nerve and not any other larger nerves. This may, for a few seconds, recreate your pain and cause a muscle twitch in your neck or back. The medial branch nerves will then be numbed so you will feel little to nothing while the nerve is being heated (locally destroyed) for one minute. This process will be repeated for usually one to five additional nerves. The entire procedure takes about 30 minutes.

What should I do after the procedure?
You will wait 30 to 60 minutes in recovery before going home. You may not drive for eight hours. You will want to substantially limit your activity for two days after the procedure.

What should I expect after the procedure?
Your neck or back may often be moderately sore during the next one to four days. This pain is usually caused by muscle spasms and irritability while the medial branch nerves are disrupted from the heat lesion over the next 7 to 14 days. Your physician will give you medicine to treat the expected spasms and soreness. Pain relief usually isn’t experienced until about two to three weeks after the procedure when, on occasion, your back or neck may feel slightly weak for several weeks after the procedure.

The nerves will eventually grow back (regenerate) but the pain may not recur in 9 to 14 months, or on occasion, sooner. If the pain does recur when the nerves grow back and the nerve signal is re-established, you may have the procedure repeated with equal success seen in most patients. Some patients never have a return of their pain, but we cannot predict when this happens.

General Pre/Post Instructions

Things that may Delay the Procedure

If you are on antibiotics please notify our office; we may delay the procedure. If you have an active infection or fever we will not do the procedure.