Thoracic facet radiofrequency neurotomy uses heat to create a lesion on the medial nerve. The lesion impairs the medial nerve’s ability to transmit signals about facet joint pain. Because the nerve is “turned off,” pain is not felt.
A thoracic selective nerve root block is an outpatient procedure. You will wear a gown for the procedure and be positioned lying face down on a table. You will receive relaxation medicine before your procedure begins. Your upper back area will be sterilized and numbed with an anesthetic medication.
Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide a needle-like tube (cannula) to the affected medial nerve. A small wire-like electrode (radiofrequency electrode) is inserted through the cannula. To ensure the cannula is in the correct position, a very mild electrical current is delivered through the electrode to the nerve. The nerve will briefly conduct pain signals and cause a muscle twitch, confirming that the correct nerve is targeted. Next, numbing medication is delivered to the nerve in preparation for the treatment. Heat is delivered through the electrode to the nerve. The heat creates a lesion on the nerve. The heat disrupts the nerve’s ability to send signals about pain. At the end of the procedure, the cannula and electrode are removed. The process can be repeated for additional nerves that require treatment.
You will be monitored for several minutes before you can return home. You should have another person drive you home because you received sedation. You should use care while resuming your regular activities over the next several days because your back will feel sore. Your doctor may prescribe pain medication, rest, and instruct you to use heat or ice packs to ease the pain.
It usually takes three to four weeks for the treated nerves to completely die. You may experience pain until the treated nerves are dead.
Thoracic facet radiofrequency neurotomy typically results in pain relief for about 9 to 14 months, or longer. About 50% of people experience pain relief for as much as two years. A small percentage of people do not experience any pain relief from the procedure. Over time, the nerves will grow back (regenerate). Some people will not experience pain again. If you experience pain, the procedure may be repeated.