Dr Thomas E Smith MB BS (Hons) MD FRCA FFPMRCA
The aim of this leaflet is to help answer your questions about having a facet joint denervation to treat your back pain.
What are facet joints?
The spine is a column of bones arranged one on top of the other. The bones are linked at the back by joints called facet joints, one on each side. The facet stabilise the spine, while also allowing movement.
The facet joints may become painful either due to wear and tear (also called degenerative change) or injury. Pain is felt around the facet joints and can spread. Pain from the joints of the lower back will often be felt in the buttocks and upper legs. Pain from facet joints in the neck can spread into the back of the head, the upper back, and shoulders. When the facet joints are tender and sensitive, the muscles nearby can become tight and painful.
What is a facet joint denervation and how does it work?
Facet joint radiofrequency denervation treatment involves placing a special needle (radiofrequency probe) next to the joint nerves. A radiofrequency current is passed down the probe. A very small area of heat is created that burns the adjacent section of nerves. This procedure does not affect any other part of the body. The treatment is usually performed after previous “test” injections of local anaesthetic to these nerves were “positive” – which means they reduced the pain for a short time.
The procedure is usually performed under local anaesthetic. If sedation is required, Dr Smith will discuss this with you beforehand. To make sure that the probe is precisely placed, x-ray imaging is used to carefully check needle positions and electrical nerve stimulation tests are used before burning.
Each joint is supplied by 2 nerves. Usually several joints are treated at the same time, so several nerves need to be treated in one session.
What is the aim of facet joint denervation?
The aim of the treatment is to reduce pain coming from the joints in the lower back. This will, in turn, help to reduce spasm in the muscles, improve mobility and reduce stiffness. The nerves grow back very slowly and this treatment aims to give a year or more of relief.
What are the risks?
Facet joint denervation is a commonly performed procedure and is generally safe. No procedure is risk free, and facet joint denervation carries a small risk of the following side effects or complications:
- Bleeding / bruising at the injection site.
- Temporary numbness / weakness from the local anaesthetic that is injected during the procedure – this usually resolves in a few hours. This can affect your back/neck and limbs.
- Stiffness and soreness for a few days after the treatment due to local trauma from the burns and needles – this can last up to 3 weeks. You should take your normal painkillers regularly and do gentle stretches.
- Nerve irritation or injury to a nerve supplying the leg or trunk that causes pain and/or numbness for weeks or months. This is estimated to occur in one case per 500.
- Permanent nerve injury to a nerve supplying the leg or trunk, which is very rare. A figure of one case per 30,000 procedures is suggested.
- A skin infection where the needle is inserted, this is estimated to occur in one per 1000 cases.
- Allergy to injected drugs – this is estimated to occur in one case per 40,000.
Are there any alternatives?
The denervation procedure is usually considered after trying less invasive treatments, such as:
- physiotherapy and lifestyle changes
- pain medication
Giving your consent
Dr Smith wants to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form that say you agree to have the treatment and you understand what it involves. But you can still ask questions after this.
What happens on the day of the procedure?
Please remember to bring with you:
- dressing gown and slippers
- any medication you normally would take (unless already advised not to)
- something to read and your mobile phone.
A nurse will admit you. You will be given a gown to change into. You can put your own dressing gown on over this gown while you wait.
Please note the time stated on your letter may not be the time of your actual procedure. This is a time set to make sure that you are prepared and ready for your procedure. Therefore, you may have to wait for a while in the preoperative area. A friend or relative will be able to stay with you while you wait.
All women of child-bearing age will be asked to provide a urine sample, for us to test to rule out pregnancy. You must tell us if you could be pregnant. X-rays are safe for adults, but may harm your developing baby, so they aren’t usually done during pregnancy.
It is important that you take all your medication as usual, unless otherwise advised. If you take blood thinning drugs or diabetes medication, then please inform us at least two weeks before your injection, to help us manage these.
Will I feel any pain?
The procedure may be performed either with you awake or sedated . Dr Smith will discuss this with you. Local anaesthetic will be used but some days of localised pain/tenderness at the treatment site can be expected.
What happens after the procedure?
You will need to stay in the Procedure Unit for at least 30 minutes after your procedure so your recovery can be monitored and we are sure that it is safe for you to go home.
Please arrange for a responsible adult to drive you home or accompany you in a taxi. We do not recommend public transport because it is not safe if you feel unwell.
You will be able to leave as soon as your nurse is satisfied that you are well enough and that there is a responsible adult to accompany you.
What do I need to do after I go home?
After the procedure and for the rest of the day, it is important for your safety that you follow the advice below:
Although you might feel fine, your reasoning, reflexes, judgement and co-ordination skills can be affected for up to 12 hours after your procedure (24 hours if you have sedation). Please rest at home for the remainder of the day.
For 12 hours (24 hours if you have sedation) after the procedure, do not:
- drive any vehicle, including a bicycle
- operate machinery
- cook, use sharp utensils or pour hot liquids
- drink alcohol
- smoke
- make any important decisions or sign any contracts.
It is important to mention that some people feel pain relief immediately after the procedure. Some people feel no immediate change but pain relief develops over subsequent days. Some people feel worse for a short period before pain relief develops. If you experience some initial soreness you should take your usual painkillers and rest until it settles.
Will I have a follow-up appointment?
Yes. You will receive either a clinic or telephone follow-up appointment to assess the effectiveness of the procedure.