Rhizotomy for Chronic Back & Joint Pain Relief

Rhizotomy: A Minimally Invasive Option for Chronic Back and Neck Pain

Some back and neck pain doesn’t come from a disc or a pinched nerve at all. It comes from the small joints along the back of the spine, and when those joints become arthritic, the ache can settle in for years. If injections have helped only for a while, or you’ve been told your facet joints are the likely source, your physician may bring up rhizotomy as a next step.

Rhizotomy is a minimally invasive, outpatient procedure that uses radiofrequency energy to quiet the small nerves carrying pain signals from those joints. It isn’t a first-line treatment for everyone. It’s usually considered after a confirmed diagnosis and when more conservative care hasn’t been enough. This page explains how it works, who may be a candidate and what recovery typically involves.

What Is Rhizotomy?

Rhizotomy is a procedure that uses radiofrequency heat to interrupt the nerves that carry pain signals from an irritated joint. In spine care, it’s also called radiofrequency neurotomy or radiofrequency ablation, and the version used for arthritic spinal joints is often called a facet rhizotomy.

During a facet rhizotomy, a board-certified physician uses live X-ray guidance to place a thin, insulated needle next to the medial branch nerves, the small sensory nerves that supply the facet joints. Radiofrequency energy then heats the tip of the needle and creates a small lesion on the nerve, which interrupts its ability to send pain signals from that joint to the brain.

Because the treatment targets the nerve rather than the joint itself, it doesn’t repair arthritis or change the spine’s structure. Its purpose is to reduce pain signals from a joint already identified as the problem.

How Is Rhizotomy Different From Other Radiofrequency Treatments?

Rhizotomy, radiofrequency ablation and radiofrequency neurotomy all describe the same basic technique: using controlled heat to interrupt a pain-carrying nerve. The difference between the related pages on our site is mainly where in the body the treatment is done and which nerves are targeted:

• Medial Branch Block: a diagnostic injection, not a radiofrequency treatment. A short-acting numbing medicine is placed near the medial branch nerves to see whether your pain eases. A positive result helps confirm that rhizotomy may be worth considering.
• Lumbar Radiofrequency Neurotomy: a rhizotomy performed on the facet joints of the lower back.
• Cervical Facet Radiofrequency Neurotomy: a rhizotomy performed on the facet joints of the neck.
• Genicular Radiofrequency Ablation: the same technique applied to the sensory nerves around the knee.
• Radiofrequency Ablation (RFA): the broad term for the technique across the spine and joints.

You may also see the term selective dorsal rhizotomy. That is a different, open surgical procedure that cuts certain nerve roots in the spinal canal, mainly to reduce spasticity in children with cerebral palsy. It is not the facet rhizotomy described on this page.

How Does Rhizotomy Work to Alleviate Pain?

Rhizotomy works by interrupting the medial branch nerves so they stop relaying pain signals from arthritic or inflamed facet joints. These small joints help stabilize the spine, and over time they can become painful from injury, everyday wear or degenerative changes.

Using live X-ray imaging (fluoroscopy), the physician numbs the skin and guides a specialized radiofrequency probe to the target nerve. The probe then delivers controlled heat to disrupt the nerve’s ability to carry pain signals from that joint.

The nerve isn’t removed, and over time it can regrow. A StatPearls review published by the National Library of Medicine notes that the length of relief depends on how long the nerve takes to grow back, which is why the procedure may be repeated if pain returns.

Am I a Good Candidate for Rhizotomy?

You may be a candidate for rhizotomy if your pain has been traced to specific joints, most often the facet joints of the spine, and diagnostic nerve blocks have confirmed it. Candidacy is always a clinical decision, and it depends on your diagnosis, your imaging and how you’ve responded to earlier treatment. Rhizotomy may be discussed for:

• Lower Back Pain: chronic low back pain from arthritis or degeneration of the lumbar facet joints.
• Neck Pain: chronic neck and upper back pain from arthritic cervical facet joints, rather than pain from a pinched nerve root.
• Facet Joint Syndrome: ongoing inflammation and irritation of the facet joints, the condition this procedure is most often used for.
• Knee Pain: chronic knee pain from osteoarthritis, treated with the related genicular approach.

Before a facet rhizotomy, most patients have a medial branch block. If numbing the medial branch nerves brings clear, temporary relief, it suggests those nerves are carrying the pain. A separate StatPearls review on lumbosacral facet syndrome notes that experts recommend two diagnostic blocks to confirm the diagnosis before moving to ablation. If the blocks don’t help, your physician will look at other sources of pain and other back pain treatment options.

Rhizotomy is generally not used for pain caused mainly by a herniated disc pressing on a nerve root, such as sciatica. Those conditions call for different treatments, which your physician can walk you through.

What Does the Rhizotomy Procedure Consist Of?

The rhizotomy procedure is an outpatient visit in which your physician numbs the area, uses live X-ray to place a thin probe beside each targeted nerve, confirms the position and then heats the nerve to interrupt its pain signals. Here’s how the day usually goes:

1. Preparation: You lie on a procedure table, and you may receive light sedation along with a local anesthetic to numb the skin and deeper tissues.
2. Probe Placement: Using fluoroscopic guidance, your physician guides a thin radiofrequency probe toward the medial branch nerve that supplies the painful joint.
3. Position Check: A mild electrical test through the probe helps confirm it is next to the correct sensory nerve and well away from nerves that control movement. Some patients feel a brief buzzing or pressure during this step.
4. Treatment: The radiofrequency generator delivers controlled heat through the probe tip for a short period at each site. Several nerves are often treated in one session, since each facet joint has more than one nerve supply.
5. Finish: A small bandage is placed over each needle site, and you rest briefly while staff monitor you.

The length of the procedure depends on how many joints and nerves are being treated.

What Kind of Recovery and Results Can You Expect From Rhizotomy?

Most people go home the same day and return to light activity soon after, though soreness at the treatment site is common for a short time. According to StatPearls, temporary post-procedure discomfort is the most common complication of radiofrequency ablation. Your physician will give you specific instructions, which often include ice, over-the-counter pain relievers as directed and light walking while you avoid strenuous activity at first.

Relief is not always immediate. Some people notice a change within the first few weeks as the treated nerves stop sending signals and any post-procedure soreness settles.

As for how long results last, that lumbosacral facet syndrome review reports that radiofrequency ablation has been shown to relieve pain for 6 months up to 1 year, at which time repeat treatment may be performed if indicated. Results vary from person to person, and the same review notes that because the nerve eventually regenerates, pain can return. Your physician will talk with you about what to expect in your situation.

Like any procedure, rhizotomy carries risks, including bleeding, infection and nerve irritation. Your physician will review these with you before you decide.