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When your back pain is a result of facet joints, facet joint injections are the first step.  When your pain is relieved by 80% with facet joint injections, a Rhizotomy may be an option for long-term relief.  Rhizotomy, also known as an RFA or ablation, is a procedure that eliminates/decreases pain to the back. It is a non-surgical procedure that is minimally invasive, and proving very beneficial to chronic facet pain. It destroys the nerves that are causing pain in the affected joints with localized heat that is generated by radiofrequency. Destruction of these nerves breaks the pain signals traveling from the spine to the brain.  In some cases, however, the nerve may regenerate back following the procedure.

What To Expect With A Rhizotomy 
It is important to discuss any medications you are taking before your procedure.  You will be asked to hold your anticoagulation therapy a certain number of days before the procedure to reduce your risk of bleeding.  You may also be asked to stop other medications prior to and after the procedure. You will be instructed on when you can resume your medications.

The procedure usually takes less than two hours.  You may experience numbness after your procedure. So, it is important that you have someone to drive you home.  You can expect some discomfort at the time of procedure, and generalized soreness afterwards.

During The Procedure
Your procedure will be done with x-ray imaging (fluoroscopy) for accuracy.  You will be asked to lie on your stomach on the exam table and remain still during the procedure.  Your skin will be cleaned with a disinfectant, and the area is numbed for better comfort. The physician will then use X-ray guidance to direct a special radiofrequency needle alongside the targeted nerves that are causing pain.  An electrical current is passed through the needle, and may cause brief pain or muscle twitching. This is a normal, enabling the physician to determine that he is in the correct area. You may feel a warm sensation during the procedure. You will be monitored shortly after the procedure, and will go home after the procedure. You can expect some discomfort at the injection site and soreness for the next few days.

After The Procedure
You should rest and relax immediately after the procedure.  You can apply ice to the injection site, if you have soreness. Pain relief is typically experienced within 10 days following the procedure, although relief may be immediate for some patients, and can take up to three weeks for others.  The pain may return if the nerve regenerates following the procedure. This is generally experienced 6-12 months after the procedure.

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