I have been a patient of Dr. Manuel Ramirez for the last 18 years. I have a disease called RSD/CRPS or Reflex Sympathetic Dystrophy/Chronic Regional Pain Syndrome. It is a nerve problem which causes deteriorating bone problems and is very painful. He initially diagnosed me and has been treating my pain with success all these years and I claim him as “family.” He is professional, but also very caring, intelligent and kind and is a great listener.
I have been under the care of Dr Ramirez for the past 8 years and can honestly say that if it wasn’t for him and his staff, my life wouldn’t be worth living. After many years of a pain filled existence, I was fortunate enough to be referred to Dr Ramirez who took a sincere interest in my back, leg, spinal and emotional problems (due to an injury sustained while I was in the Army back in 1969) and his treatment has allowed me to live a much improved quality of life than I had previously experienced for the past 30+ years. It’s so refreshing to have a healthcare professional who actually listens to my concerns and problems and in turn treats these issues in a calm, professional and reassuring manner. Should you have issues with constant pain that interferes with your everyday quality of life, don’t give up. Go see Dr. Ramirez, you’ll be glad that you did.
This procedure is done to treat pain caused by the facet joints by creating a lesion or burn to the nerve fibers that mediate pain in these areas, including the medial branch nerve of the posterior primary ramus. This is done to reduce pain and improve function lasting longer than the effects of the facet block or medial branch nerve block. This is accomplished by placing a special insulated needle alongside the facet joint under x-ray fluoroscopic guidance and intravenous anesthesia. The area is lesioned using a controlled heat, to decrease the sensation of the facet joints. In addition to the X-ray guidance, nerve testing is performed to confirm the proper positioning of the needle. The procedure usually takes less than an hour, after which you would be monitored in the post anesthesia care unit for an additional 30-60 minutes to ensure your safety and comfort. You may experience some discomfort at the needle puncture sites following the procedure for which ice packs are effective. The effects of the procedure may take a few days to manifest itself. Because of the intravenous anesthesia, you are asked not to eat anything after midnight, the day of the procedure and have somebody drive for you. This procedure can also be done to lesion the sympathetic nerves.
About Radiofrequency Lesioning/Rhizotomy
Radiofrequency lesioning is a surgical procedure where special needles heat the nerve up to 80°C for a few minutes in order to stop the nerve from being able to carry a pain signal back to the brain.
“Rhizotomy” is a medical term that refers to a neurosurgical treatment that selectively paralyzes problematic nerve roots in the spinal cord in order to relieve issues related to neuromuscular conditions, such as chronic pain.
Radiofrequency rhizotomy is a procedure implemented to reduce and/or eliminate nerve pain when more conservative pain treatments have not worked. The procedure involves localized heat generated with radiofrequency to render the nerves inoperable. By doing so, pain signals are prevented from being sent.
About the Procedure
Fluoroscopy (X-ray) is used to determine proper needle placement and a small amount of local anesthetic is injected to numb the area. The small amount of local anesthetic administered may feel like a little pinch accompanied by a slight burning sensation as the medicine begins to numb the area. Once the numbness has taken effect, high radiofrequency voltages are applied to the needle to heat the nerve to the desired temperature. The patient may feel some pressure at the injection site each time the nerve root is heated. This will be repeated for each nerve root that is problematic.
Since the procedure may cause temporary discomfort, the patient will be sedated, partially or fully at the doctor’s discretion.
What to Expect After this Procedure
After the procedure and ample time for recovery, the patient needs to have someone drive them home. Slight discomfort and muscle soreness in the area the treatment was given can last for up to one week.
For relief, ice packs applied to the procedure area are recommended. Additionally, your doctor may prescribe medication to help with the temporary discomfort the patient may experience. While the average patient has marked pain relief within a week after the procedure, it can take up 3-4 weeks to feel significantly better.
Barring anything out of the ordinary, the patient should be able to return to work the very next day. Physical activity, however, should be avoided until recovery is complete.
Risks of Radiofrequency Lesioning
Serious complications from radiofrequency lesioning are not common. Aside from the temporary post-procedure discomfort already discussed, the following are unlikely, yet possible, side effects from this treatment:
- Long-term numbness
- Nerve injury