Read a brief description of the neurotomy and diagnostic blocks procedures.

If a facet joint is damaged, there is at present no way to easily see, let alone fix the damage. However facet joint injury only has one symptom - pain. Therefore the pioneers of the neurotomy procedure decided that if they could not fix the cause of the pain, why not fix the symptoms - stop the pain. Pain travels along nerves, if the nerves are removed the pain has no way of getting around so the body remains unaware of it. This is basically what is involved in the neurotomy procedure - the nerves carrying the pain from the damaged joints to the central nervous system are simply burnt through so the pain has nowhere to go. A radiofrequency transmitted to the area via a small needle causes surrounding tissue to vibrate and thus heat up to make the burn. The pain is eliminated for on average 12 - 14 months before the nerves grow back - at this time a second neurotomy can be performed with similar results if the pain returns and it proves necessary. Find out more by reading the articles detailed on the links page.

The diagnostic nerve blocks perform the same function as the neurotomy in that they stop the pain signals travelling. Here however an anaesthetic agent is carefully positioned to inject over the nerves coming from each joint and the effect it has on the pain evaluated. The procedure can last for anything between 20 - 90 minutes and the process basically goes: Insert needle to near the nerve coming from (e.g.) c5/6 joint, use x-ray to ensure needle is in the correct area, inject a contrast dye to view whether the anaesthetic will cover the required area, if so inject the anaesthetic, wait for it to take effect and evaluate the effect, e.g."wahay the pain I've had in my left shoulder for 18 months seems to have gone!" The process is repeated systematically working through the nerves until hopefully all the pain is gone. Though this relief only lasts for the duration that the anaesthetic is working it does illustrate conclusively that the joints are the cause of the pain and which nerves can be denervated to provide long lasting pain relief. Studies show that confirmatory blocks at a later date using a different anaesthetic can increase the diagnosis accuracy from around 70% (initial blocks have a false positive rate of about 32%) to over 90%. These processes are illustrated below, click on the doc to start the sequence. Find out more by reading the articles detailed on the links page.

DIAGNOSTIC BLOCKS...

A contrast dye is then injected to ensure the anaesthetic will cover the required area. If this is ok the anaesthetic is ready to be injected. If not the needle is adjusted for a second attempt.

S Anaesthetic

The anaesthetic is then injected and given time to take effect. The effect (or lack of effect) on the pain is recorded and the procedure is repeated on the next nerve. The process may be repeated at a later date with a different anaesthetic to increase the accuracy of the results.

The procedure for the neurotomy is similar, the needle is placed in the general area and an x-ray taken.

S Contrast Dye

The needle is inserted to near where the nerve to be anaesthetized is believed to be positioned. An x-ray is taken to confirm the position.

NEUROTOMY...

This time a small current is sent through the needle to provoke a tingling sensation to confirm that the needle is close enough to the required nerve.

~ Small electric current.

A radiofrequency sent through the needle heats up the surrounding tissue which burns through the nerve.

* Heat burns through the nerve.

Click REFRESH if you want to replay the sequence.