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.

Answers to frequently asked questions

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.

  • 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.

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.

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