Medial Branch Nerves
Facet joints are a set of small joints between every two adjacent vertebrae in the spine. Their function is to guide and limit the movement of each spinal segment adjacent vertebrae in the spine. Cervical facet joints are responsible for neck range of movement, thoracic facet joints for the upper back’s ability to articulate and bend, while lumbar facet joints provide these functions for the lower back.
Medial branch nerves are the small nerves that carry pain signals to the brain. Each facet joint is connected to two medial nerves that carry pain signals away from the spine to the brain. Thoracic medial branch nerves are located over a bone in the mid-back or upper back and lumbosacral medial branch nerves are found in a bony groove in the lower back.
Radiofrequency Denervation is a minimally invasive pain management technique which permanently blocks nerve pain. The nerve responsible for the pain is desensitised using radiofrequency, rendering it incapable of sending pain signals on a permanent basis. As a consequence of the permanency of the procedure, it’s not performed without prior consideration to other more conservative pain management treatments.
Radiofrequency denervation is usually performed in cases where nerves become a source of debilitating and constant pain in the thoracic (upper) or lumbosacral (lower) spine.
Recent research has indicated that radiofrequency denervation is an extremely effective procedure in treating conditions which have failed to respond to other therapies, such as other more conservative treatments. A recent study revealed that almost 92% of patients who have undergone this procedure, have returned to work just in two weeks.
Radiofrequency denervation is carried out after a patient has been given a local anaesthetic and occasionally minimal sedation. A needle will be inserted, using X-ray guidance to direct the needle to the small branch of the nerve which is creating the pain sensation.
For safety purposes, tests will also be carried out to ensure that the needle is as close as possible to where it is needs to be. A small electrical signal is used to test this, by providing information to the doctor on how close the needle tip is to the relevant nerve. This is also necessary to remove the risk of the needle tip being too close to the main nerve which governs motor control.
Once these conditions have been met, the radiofrequency is administered and the nerve is effectively destroyed. The radiofrequency heats it to around 80˚C, ensuring that the nerve will have a permanent lesion and thus be ineffective in transmitting pain signals.
In order to reduce the post-process soreness, a small dose of local anaesthetic and corticosteroid is deposited at the site. Several small nerves have to be treated in this manner. Therefore, this procedure might take an hour or longer to be completed in its entirety.
The procedure is undertaken on an outpatient basis and the patient is generally allowed to immediately return to normal activity, depending on the individual situation. After a fortnight or so the nerve will be completely inactive and the pain will be eradicated, allowing the patient to return to a pain free existence.
Radiofrequency denervation is an extremely safe procedure and carries a minimal risk of side effects or complications. Such interventional procedures are generally carried out under constant X-ray screening, which enables the specialist to monitor the position of needles or instruments, considerably minimising the risk of any complications.
A recent survey report stated that radiofrequency denervation reported a minor complication rate of 6.5%, when performed using appropriate techniques and equipment. In some cases, minor side effects like soreness or pain in the affected area might be experienced.