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Rhizotomy / Denervation

What is a Rhizotomy?

A rhizotomy is a minimally invasive procedure to provide pain relief by disrupting the pain signals that the facet joints send to the brain. Pain relief can be for months or even years. Candidates for rhizotomy have usually undergone between one and three facet joint injections to verify the source and location of their pain. Prior to the procedure, you may be asked to have a neurological or psychological examination. You may also be asked to have a pre-procedure physical with an internal medicine doctor.

What happens during the procedure?

Prior to the procedure, you will be asked to sign a consent form. A nurse will check your vital signs, and ask what medications you are currently taking and if you are allergic to any medications, and put in an IV. The doctor performing the procedure will review your medical history and talk with you prior to the procedure.

Lying face down on the table, in the procedure room, the area will be cleansed with an antiseptic solution and the skin will be numbed. An anesthesiologist will be present to administer anesthesia during your procedure.

With the assistance of a C-arm fluoroscopic unit (x-ray) the physician directs a probe with a temperature-monitored electrode to the correct area. The electrode deadens the sensory nerve, interrupting the sensory nerve pathways. When the procedure is completed, the probe is removed and the entry points will be bandaged.

You will return to the recovery room for observation. The nurse will re-check your vital signs at this time. Initial discomfort may be experienced after the procedure, including bruising, soreness, or swelling at the injection site. Most patients are able to resume normal activity the next day. Your back may be sore for a few days after the procedure and may be treated with ice packs, over the counter pain medications, or your doctor may give you a prescription for pain medication if needed.

How do I prepare for the Rhizotomy:

  • Nothing to eat or drink 6 hours prior to procedure.
  • Discontinue all medications after midnight before your procedure. If you are on routine medications for heart, blood pressure or diabetes, you can take your medication as usual the morning of your rhizotomy with a sip of water.
  • Discontinue anti-inflammatory medication such as ibuprofen or naproxen three days prior to the procedure.
  • Discontinue aspirin products seven days prior to your procedure.
  • If on blood thinners such as Coumadin, Plavix or Pradaxa, contact the prescribing physician to stop the medication seven days prior to the procedure.

What do I need to do on the day of the Rhizotomy?

  • You must have an adult driver with you
  • Make and bring a list of all medications, both prescribed and over-the-counter with you to the injection along with your photo identification and insurance card(s).
  • Plan to arrive one hour prior to your injection time to check-in and register at the facility.

Other than pain, associated symptoms may include weakness, numbness or tingling.

Fortunately, most forms of back pain get better on their own: approximately 50 percent of patients will experience back pain relief within two weeks and 90 percent within three months.

If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor.

Drug Information

Anti-inflammatory drugs that need to be stopped 3 days prior to your injection

  • Advil,Ibuprofen, Nuprin, Motrin
  • Naprosyn, Naprelan, Naproxyn, Alleve, anaprox
  • Lodine, Etodolac
  • Orudis, Oruvail, Ketoprofen
  • Ansaid
  • Cataflam, Voltaren, Diclofenac, Arthrotec
  • Feldene, Iroxicam
  • Tolectin, Tomletin
  • Nalfon, Fenoprofen
  • Meclomen, Meclofenamate
  • Daypro, Oxaprozin
  • Clinoril, Sulindac
  • Indocin, Indomethacin
  • Relafen (Nabumetone)
  • Dolobid, Difunisal
  • Ponstel, Mefenamic Acid
  • Toradol, Ketoralac
  • Mobic

Aspirin products to stop taking 7 days prior to your injection:

  • Apsirin, Bufferin, Excedrin, Disalcid, Salsalate, Alka Seltzer Plus, Trisilate
  • Anything that has “salicylic” or “salicylate” on the label

It is alright to continue taking:

  • Celebrex

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