frequent procedures
 

FACET DENERVATION PROCEDURE
Facet denervation procedure involves the denervation of the twigs of nerves that supplies the facet joint at the level involved. This is also called the medial branch block. The aim of this denervation is to achieve cessation of transmission of pain signals from the facet joint itself, which could be previously arthritic or inflamed and generating pain, from reaching the spinal cord and being transmitted as pain. Facet denervation procedure can be done at the cervical, the thoracic, or the lumbar level or the sacral spine level.

INDICATIONS:

• Cervical facet arthropathy.

• Thoracic facet arthropathy.

• Lumbar facet arthropathy.

• Other indications include traumatic spondylopathy at the cervical, thoracic, or lumbar level.

TYPES: There are two types of approach to facet denervation. The commonly used approach, which is also effective and provides prolonged relief, is radiofrequency lesioning of the facet nerves. This can be done by using a Radionics instrument used in denervating the facet nerves. Another option/technique that is used to achieve this denervation process is called cryoablation. Cryoablation is achieved by using a probe that is frozen after being inserted into the tissue next to the nerve ending for which a pain block is being attempted. This circumferential freeze encases the targeted nerve or twig of nerve and results in interruption of pain transmission along that nerve. The radiofrequency lesioning process is accomplished by the use of a radiofrequency controlled probe, which is inserted into a protected canula whose exposed tip lies next to the targeted nerves (medial branch) followed by a small local anesthetic instillation in the surrounding area and the denervation of the nerve using controlled heat over an approximately one and a half minute interval for each affected nerve. These lesions tend to achieve the desired goal of pain relief.

COMPLICATIONS: Complications are extremely rare since prior to lesioning these facet nerves localization is confirmed by x-ray as well as by both sensory and motor stimulation testing of the inserted canula and probe to confirm appropriate placement before lesioning. The actual lesioning itself is usually painless after instillation of a small amount of local anesthetic before the actual treatment. The benefits to this procedure can be very long lasting to permanent. It is also understood that following a facet denervation procedure the joint affected tends to be more mobile because of lack of restriction from pain and spasm and tends to become more active resulting in improved blood flow and improved healing of the primary pathologic process itself, especially when physical therapy accompanies the use of this treatment technique as an adjunct.

CONTRAINDICATIONS: Like any x-ray guided procedure, pregnancy is a contraindication for this procedure. Patients on Coumadin and heparin should also be advised to discontinue the use of these agents with the approval of their prescribing physician about three days prior to this procedure being done, in the case of coumadin. the anti-coagulant medications, however, may be resumed on the same day after the procedure is done. Patients are not require to discontinue their routine blood pressure or diabetes medications or other similar medications before this procedure is done or after.

SEDATION: Sedation is not indicated but can be made available on request. Patients who are also anxious may also be allowed to take sedatives (pre-medication) before undergoing the procedure.

 

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