This procedure is also known as thermocoagulation, posterior ramus blocks and percutaneous facet denervation.
This treatment involves facet joint denervation, or “burning” the nerve (posterior medial branch) that innervates the posterior vertebral joint.
The facet joints may be responsible for pain at every level of the spinal column. Patients who responded well to the medial branch block tests may benefit from facet ablation.
The results are usually satisfactory when patients have been properly selected through medial branch block testing. Relief can be permanent, but it is more commonly temporary. In fact, the posterior medial branch may grow back over time. A second ablation can then be performed if it is considered necessary.
The physician identifies the location of the posterior medial branch under fluoroscopic guidance (radiography). After disinfecting the skin and applying a local anesthetic if needed, he ensures the trocar is properly positioned on the nerve (posterior medial branch) using low-intensity electrical stimulation. If not, the needle is repositioned and the low-intensity electrical stimulation is repeated until the trocar is properly positioned.
A deep anesthetic is then administered. A higher-intensity current is then applied, which heats the trocar tip and “burns” the nerve. This part of the treatment is usually painless because the patient has been locally anesthetized. The procedure may be applied at several levels of the spine. After the treatment, the patient returns to the recovery room for approximately 20 minutes.
After the procedure, the patient may feel numbness or weakness in a limb due to the anesthetic administered during the procedure. These temporary symptoms may last from a few minutes to a few hours.
Complications are essentially related to the injection, the anatomy involved and the substances injected. Using radiography to confirm the trajectory of the trocar during the procedure enhances its safety. The low-intensity electrical stimulation administered before the treatment also helps prevent complications. The risks of complications, such as infection or hemorrhaging, are the same as for any other type of injection, and are quite rare.
Sometimes the use of anticoagulants and Plavix must be stopped before the procedure. If this is necessary, the patient’s prescribing physician must authorize a temporary pause of these medications. This procedure is contraindicated during pregnancy. Report all allergies to medications or contrast agents to the physician. Please note that ablation cannot be performed on patients who have a pacemaker.