Candidates for this procedure will have to have diagnostic tests called medial branch blocks which are needle-based procedures where numbing medicine alone is placed on the medial branch nerve. If an individual receives greater than 70% pain relief, then the patient is a candidate for a neurotomy.
The procedure is performed under X-ray guidance. The patient is face down on an X-ray table and lidocaine is usually administered to the patient. The skin is cleaned and the X-ray machine is positioned over the patient. Using a monitor, numbing medicine is placed under the skin using a very small diameter needle. Then under X-ray guidance, the specialized needle is placed near the spine at the location of the medial branch nerve. Once the needle is in the proper position, the numbing medicine is placed through the needle and then a small amount of energy from a radiofrequency generator is released. The needles are heated up for greater than 90 seconds, usually about 3 minutes. Once the heating is completed, the needles are then removed. The external site is usually covered by a bandage, and the patient will go to the recovery room for about 30 minutes to be monitored.
After the patient has completed the monitoring period, they will be released home. The patient must be driven by a responsible adult. It is normal to have pain at the needle insertion site for several hours and the possibility of a sunburn sensation (post-procedural neuritis) for over 2 weeks.
The risks and possible complications of this procedure include but are not limited to:
- Superficial or deep nerve injury
- Worsening pain
If the patient develops severe pain, weakness in an extremity, or fever they must call their doctor immediately.
Pre-treatment instructions: The patient’s medications will be reviewed, and sometimes certain medications will be stopped prior to the procedure. As mentioned above, prior to a neurotomy the patient will have a medial branch work up.