Project Description

Dr. Tory McJunkin performs a cervical radiofrequency ablation. This pain relief technique can be used to treat a number of painful conditions and pain sources.

Watch Pain Doctor Tory McJunkin Perform a Cervical Radiofrequency Ablation

Cervical pain is pain that arises in the neck and upper back region. This type of pain can be caused by many factors and can be quite common. In fact, previous studies have estimated that nearly two-thirds of the population will suffer from some form of neck or upper back pain during their life. Some of the more commonly reported causes of neck or upper back pain include pinched nerve, muscle strain, herniated/slipped intervertebral disc, or direct trauma or injury.

Treatments for cervical pain can vary widely, though most are minimally invasive and do not require surgery. Radiofrequency neurotomy of the cervical facet joints is one of these treatments. In fact, radiofrequency of the cervical facet joint is one of the most commonly performed treatments for managing pain that arises within the cervical facet joints.

Existing evidence has provided some support for the role of cervical facet radiofrequency neurotomy in providing relief from moderate to severe neuropathic cervical facet joint pain. Studies have also examined the long-term benefits of this treatment. Findings from these studies indicate that most patients can expect to be free from neuropathic pain for up to 15 months following the procedure. Further, approximately 50% of the patients in these studies were reported to be free from symptoms for up to two years following the procedure.

How Is Cervical Facet Radiofrequency Neurotomy Performed?

In the body, located on the posterior sides of the spinal column, are the facet joints. Many of the facet joints have very limited ranges of motion owing to their shape; however, the facet joints located within the cervical area have a unique shape. This allows them to have a more broad range of motion. Damage to these structures can lead to soreness, joint stiffness, inflammation, and pain in the area of the neck and upper back.

The spinal cord is the primary pathway within the nervous system by which sensory information is transported from the peripheral areas of the body back to the brain. Owing to this crucial function within the body, the spinal cord must remain quite protected. Around the spinal cord is a durable and protective membrane. This membrane provides a protective barrier around the spinal cord and holds in the cerebrospinal fluid (CSF). Outside of the spinal canal lies the spinal column, which is a flexible bony structure that provides additional support for the spine. Medial nerves branch off of the spinal cord and serve the peripheral areas. Specifically, these nerves transmit sensory information and provide muscle control to the facet joints.

The precise mechanism of cervical facet radiofrequency neurotomy is not completely understood. In general, it is believed that this treatment works by inhibiting the transmission of pain information from the facet joint area to the spinal cord and brain within the medial nerves. The procedure itself is safe and can be conducted on an outpatient basis. Typically, the performing physician will only use a local anesthetic during the procedure; however, some individuals may wish to have an intravenous medication so that the procedure is more comfortable.

During the procedure, the physician will use an X-ray imaging device. This is used to guide the injection needle, known as the cannula, into the appropriate area of the nerve. Prior to the neurotomy, the performing physician must ensure that the electrode has been placed in the proper location. In order to do this, the physician will run a mild electrical current through the electrode. This will produce temporary pain signals and muscle contractions, allowing the physician to identify the nerve. After it has been confirmed that the needle has been placed in the proper area, the physician will deliver a numbing solution to the area. Then, a high degree of heat is applied to the area through radiofrequency. This creates a lesion on the nerve tissue and acts to inhibit the function of the nerve.

After the procedure has been performed, patients who have received a cervical facet radiofrequency neurotomy procedure can generally expect to be monitored closely by their physician for any signs of an adverse reaction. It is generally recommended that patients do not drive themselves home following the procedure. Further, your physician will likely advise that caution is used when returning to regular daily activities in order to avoid risk for further injury.

In most cases, patients can expect damaged medial nerves to take nearly one month to fully atrophy. During this period, it is not uncommon for cervical facet radiofrequency neurotomy patients to report ongoing symptoms of muscle soreness and weakness in the area. You may wish to speak to your doctor about appropriate medications to be used for temporary pain relief until the facet joint nerves completely die off.

Similar to many other medical procedures, there is some risk associated with cervical facet radiofrequency neurotomy, though they are generally rare. A small number of patients will report:

  • Numbing of the skin above the treated area
  • Pain or discomfort near the site of the injection
  • Muscle spasms
  • Allergic reactions to the medication
  • Infection
  • Permanent nerve damage and pain

Conditions Related To Cervical Facet Radiofrequency Neurotomy

Radiofrequency neurotomy in the cervical facet joint area can be used to treat pain and discomfort that accompanies many conditions of the facet joint. The primary goal of cervical facet radiofrequency neurotomy is to allow the patient to receive relief from pain; however, each individual will respond to the treatment differently. It is important for you to talk to your doctor about whether this procedure is appropriate for your condition.

Previous studies have provided some support for the role of cervical facet radiofrequency neurotomy in treating the pain and discomfort associated with whiplash. Other conditions that may be effectively treated with this procedure include:

  • Pain that improves when lying down
  • Pain that worsened when twisting or lifting a heavy object
  • Any pain of the upper back

Conclusion

Radiofrequency neurotomy of the cervical facet joint is a non-surgical treatment option for managing the pain and discomfort associated with cervical neuropathy. It is not invasive and can be performed on an outpatient basis. Recovery following the procedure can take up to one month; however, many patients can expect to be free from symptoms for approximately two years. Patients are encouraged to speak with their doctor about the appropriateness of this procedure for managing their symptoms of cervical pain.

References

  1. Cohen SP, Husang JH, Brummett C. Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101-16.
  2. Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Leg Med. 2013;20(2):74-85.
  3. Falco FJ, Datta S, Manchikanti L, Sehgal N, Geffert S, Singh V, Smith HS, Boswell MV. An updated review of the diagnostic utility of cervical facet joint injections. Pain Physician. 2012;15(6):E807-38.
  4. Falco FJ, Manchikanti L, Datta S, Wargo BW, Geffert S, Bryce DA, Atluri S, Singh V, Benyamin RM, Sehgal N, Ward SP, Helm S, Gupta S, Boswell MV. Systematic review of the therapeutic effectiveness of cervical facet joint interventions: An update. Pain Physician. 2012;15(6):E839-68. Review.
  5. Husted DS, Orton D, Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain. J of Spinal Disorders & Techniques. 2008;21(6):406-408.
  6. Mukai A, Kancherla V. Interventional procedures for cervical pain. Phys Med Rehabil Clin N Am. 2011;22(3):539-49.
  7. Van Eerd M, de Meij N, Dortangs E, Kessels A, can Zundert J, Lataster A, Patijn J, van Kleef M. Long-term follow-up of cervical facet medial branch radiofrequency treatment with the single posterior-lateral approach: An exploratory study. Pain Pract. 2013;18
    [Epub ahead of print].