Radiofrequency Neurotomy

Rating

Category: Medical Options

Injury Type: Chronic

What is it?

Radiofrequency neurotomy is a procedure which aims to disrupt the nerve supply to the joints in the spinal column. These joints are called facet joints. The disruption of the nerve supply is called denervation. In this process an electrode or a probe is inserted via a needle under local anaesthetic and using X-rays. When the probe is close to the nerve, heat is generated which interrupts the nerve conduction. Therefore, the nerve supply to the facet joint is interrupted.

How does it work?

Radiofrequency neurotomy works on the premise of disrupting the conduction of pain signals from the facet joints by interrupting its nerve supply. By interrupting the nerve supply, the pain signals are not carried to the brain and hence the perception of pain is reduced.

Is it effective?

This is an emerging area of practice and, as such, the evidence is limited. There are some high quality publications which support the use of radiofrequency neurotomy for patients suffering from long term whiplash injuries. The reported benefits include pain relief, range of motion, muscle strength and psychological well being. In some instances the benefit lasted up to a year. These findings, however, seem to be specific to patients with whiplash whose symptoms primarily arise from facet joints.

Are there any disadvantages?

During the procedure, it is possible that patients may receive a number of medications. These can have side effects such as drowsiness, temporary numbness, weakness and soreness. The area where the needle placement occurred can also be painful. These and other symptoms must be reported to the health professional for regular monitoring.

Where do you get it?

Radiofrequency neurotomy can only be undertaken by a registered medical health professional who is a specialist in this field (such as a radiologist).

Recommendations

There is an emerging body of evidence to suggest that radiofrequency neurotomy may be beneficial for patients with whiplash injuries whose signs and symptoms are as a result of facet joint problems and of a longstanding nature. However, it is unclear how often radiofrequency neurotomy can be repeated for patients with whiplash. More research is required to identify if this treatment will be beneficial for all patients suffering from long term whiplash symptoms.

Key References

  • Carragee, E, Hurwitz, E, Cheng, I, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Hogg-Johnson, S, Van der Velde, G, Cassidy, D & Haldeman, S 2008, 'Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders', European Spine Journal, vol. 17, pp.153-169.
  • Prushansky, T, Pevzner, E, Gordon, C & Dvir, Z 2006, 'Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures', Journal of Neurosurgical Spine, vol. 4, pp. 365-373.
  • Sapir, DA, Gorup, JM, 2001, "Radiofrequency Medial Branch Neurotomy in Litigant and Nonlitigant Patients with Cervical Whiplash", Spine, vol.26, no.12, pp E268-E273.
  • Schofferman, J, Bogduk, N & Slosar, P 2007, 'Chronic whiplash and whiplash associated disorders: an evidence based approach', Journal of the American Academy of Orthopaedic Surgeons, vol. 15, no. 10, pp. 596-606.
  • Seferiadis, A, Rosenfeld, M, Gunnarsson, R, 2004, "A review of treatment interventions in whiplash-associated disorders", European Spine Journal, vol. 13, pp. 387-397.
  • Suijlekom, HV, Mekhail, N, Patel, N, Zundert, JV, Kleef, MV & Patijn, J 2010, 'Whiplash- associated disorders', Pain Practice, vol. 10, no. 2, pp. 131–136.
  • Yadla, S, Ratliff, J & Harrop, J 2008, 'Whiplash: diagnosis, treatment, and associated injuries', Current Reviews in Musculoskeletal Medicine, vol. 1, pp. 65-68.
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