What is medial branch neurotomy?

Medial branch neurotomy is a procedure to help relieve long-term pain. It uses radio waves to damage nerves in your neck or back so they no longer send pain messages.

Medial branch nerves carry many of the pain messages to your brain from the facet joints in your neck and back. These are the joints that connect your vertebrae to each other. Problems in these joints can cause long-term pain.

The doctor will first use a tiny needle to numb the skin. Then the doctor will put the neurotomy needle into the numbed area. You may feel some pressure, but you should not feel pain.

Activity

• You may want to do less than normal for a few days. But you may also be able to return to your daily routine.
• You may shower if your doctor okays it. Do not take a bath for the first 24 hours, or until your doctor tells you it is okay.

Diet

• You can eat your normal diet.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, as your doctor if you can take an over-the-counter medicine.
• You should be able to take your regular medicines again soon after the procedure. Your doctor may give you instructions on when to restart certain medicines, such as aspirin or a blood thinner like Coumadin.

Ice

• If the area feels sore or tender, put ice or a cold pack on it for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

It takes 20 to 30 minutes to get the block. You can go home after the doctor watches you for about an hour.

It takes 45 to 90 minutes to get a neurotomy, depending on how many nerves are heated. You will probably go home 30 to 60 minutes after the procedure.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic (long-term) pain in the neck or back.

Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

Radiofrequency medial branch neurotomy is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to damage nerves in your neck or back so that they can no longer send pain messages to your brain.

Before your doctor knows if a neurotomy will help you, you will get a medial branch block to find out if certain nerves are the ones that are a source of your pain. You will need two separate visits to the outpatient center or hospital to have both procedures.

You will need someone to drive you home.

You will get instructions on how to report how much pain you have when you are at home.

You may feel a little sore or tender at the injection site at first. But after a successful neurotomy, most people have pain relief right away. It often lasts for several months, but your pain may come back.

If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.

Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic (long-term) pain in the neck or back.

The medial branch nerves are the nerves that carry many of the pain messages from your facet joints.

During your medial branch neurotomy, your doctor used radio waves to damage a nerve in your neck or back to help your pain.

You may feel a little sore or tender at the injection site at first. After a successful neurotomy, most people have pain relief. And it usually lasts for several months, but your pain may return.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure will take 45 to 90 minutes.

The doctor will use a tiny needle to numb the skin where you will get the block. Then the doctor puts the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, the doctor injects medicine onto one or more nerves to make them numb.

If you get relief from your pain in the next 4 to 6 hours, it's a sign that those nerves may be contributing to your pain. The relief will last only a short time. You may then have a medial branch neurotomy at a later visit to try to get longer relief.