Rhizolysis or Radiofrequency
Although it is not a technique that we promote or practice at Biziondo, it is currently a common technique used for pain.
Chronic pain in any segment of the back or spine can originate from injuries or alterations in various structures, such as the intervertebral discs, ligaments, muscles, or degeneration that may occur in various joints, including the facet joints.
These facet joints (or simply facets) correspond to the connections between the vertebrae, which stabilize spinal movements. Because these structures are made of bone and have a contact surface, they can suffer inflammatory overload due to arthritis, sprains, or local inflammation; or, more commonly, they can also present with degenerative changes, primarily due to osteoarthritis, which is known as "facet osteoarthritis" or "facet syndrome."
Facet pain is characterized by a predominance of morning pain associated with stiffness; it may decrease in intensity over time and with daily activity. This pain can occur in the cervical (neck), dorsal (upper back), or lumbar (lower back, where it is most common). It may be felt primarily when beginning any activity after a considerable period of rest. It may also intensify with activities that involve rotation or extension of the back, and may even project to the buttocks or the back of the thighs.
Among the most commonly used treatment options for facet joint syndrome is rhizolysis or rhizotomy, a minimally invasive procedure that involves denervation or "controlled damage" to the nerve endings that carry back pain information, in this case the affected segment. This procedure can be performed using radiofrequency radiation to the affected area, which is the most commonly used method, or by injecting drugs (anesthetics and anti-inflammatories) directly into the identified nerve.
El objetivo principal de la rizólisis se centra en “cortar” las conexiones transportadoras de señales de dolor, las cuales pueden tener un origen en la compresión ejercida por las facetas. Si esto se comprueba por medio de exploración clínica y el apoyo de imágenes diagnósticas, sumado a que los tratamientos conservadores no han sido efectivos y el dolor crónico incapacitante interrumpe las actividades cotidianas, este procedimiento estará indicado para el tratamiento sintomático, buscando mejorar la calidad de vida del paciente.
The procedure is relatively simple. Initially, an injection or "diagnostic block" (usually guided by X-ray or ultrasound) is performed in an operating room on the nerves that supply sensation to the facet joints, using a local anesthetic and steroids (anti-inflammatories). If this procedure shows improvement in pain, radiofrequency sessions will be scheduled weeks later to cause "controlled damage" to the local nerves that carry the pain. This procedure described above may be repeated on several segments of your back to ensure the effectiveness of the method, since the facet joints may be connected to nerve endings that emerge from adjacent vertebrae.
Rhizotomy is an outpatient procedure that can be performed in approximately 20 to 30 minutes, and pain is not common during the procedure. Risks during the procedure are rare and may be related to excessive diffusion of the local anesthetic, accidental injury to a nearby nerve, or, in very rare cases, infection or bleeding in the treated area. Warning signs that require an emergency room visit include fever and numbness in the hands or legs. Postoperative rest is generally indicated for a few days and avoiding moderate to intense physical activity for a few more days.
The pain-reducing effect of rhizotomy can be felt from the first few days to about two weeks later. Its benefits include reported pain relief and maintaining the ability to perform daily activities, improving the patient's quality of life.
Finally, it's important to remember that the use of rhizotomy, and even more so its follow-up, must be based on individualized care. Therefore, it's essential to conduct close follow-up checks after the procedure to assess the patient's progress and thus ensure the treatment's effectiveness and comprehensiveness.
