How it works
How rhizotomy works
A rhizotomy interrupts the signals from a nerve that supplies a painful facet joint. Facet joints are small joints between and behind the bones of the spine. When they are irritated, they can cause pain, especially when you bend or twist.
For the procedure, x-ray guidance (fluoroscopy) is used to place a needle next to the correct nerve. An electrode in the needle sends radiofrequency energy, which creates heat at the nerve. The heat interrupts the nerve’s ability to send pain signals.
How rhizotomy and radiofrequency ablation relate
Rhizotomy and radiofrequency ablation (RFA) are closely related. “Rhizotomy” names the goal, which is to interrupt a pain nerve. Radiofrequency ablation names the method, which uses radiofrequency heat. A facet rhizotomy is done with radiofrequency heat, so these two pages describe much the same kind of procedure. This page focuses on facet joint pain in the neck and back. The RFA page covers the technique in more detail and other areas where it may be used.
Who may benefit
Who may be a candidate for rhizotomy
Rhizotomy may be considered for long-lasting pain from the facet joints in the back or neck. This kind of pain often gets worse when you bend or twist. It may also be used for pain from the sacroiliac (SI) joint and the knee.
Rhizotomy is not usually a first treatment. You may be a candidate if you have tried more conservative care and your pain continues. A facet or medial branch block is always done before a rhizotomy, and your provider looks for a good response to it. Relief from the block suggests the facet joint nerve may be the source of your pain. Each case is reviewed individually to build a plan for you.
What to expect
What to expect before, during and after a rhizotomy
Before your procedure
A facet or medial branch block is always done first. Your provider will review your history and the results of the block, explain the plan and tell you how to prepare. Tell the team about your medicines and allergies.
During the procedure
Rhizotomy is an outpatient procedure. Your provider will discuss sedation options for your procedure at your visit. A physician uses x-ray guidance to place the needle at the right nerve and applies radiofrequency heat through the electrode.
After your procedure
Your team gives you aftercare instructions. You may be watched for a while, and you go home the same day. You may have bruising, swelling or soreness where the needle went in. Ice and over-the-counter pain medicine may help in the days after. You may need a follow-up visit so your provider can review your plan.
Benefits and limitations
How long the effect may last
Many patients notice relief within a few days to a few weeks, but everyone is different. Relief can last for months for some patients, but it varies with the person, the area treated and any other conditions. Your provider will review what to expect.
Nerves can grow back over time, and if that happens the pain may return. If the procedure helped you, it can be repeated.
Risks and side effects
Risks and side effects of rhizotomy
Possible side effects include soreness, bruising or swelling at the treated area. Less often, there may be temporary numbness, infection, a temporary rise in pain or nerve injury.
Please talk with your provider about the risks that apply to you, and how they compare with the possible benefits, before you decide.
Common questions
Questions about rhizotomy
Your provider can talk through your own plan at your visit.
What is a rhizotomy procedure?
A rhizotomy uses heat from radiofrequency energy to interrupt a nerve that carries pain signals from a painful facet joint. A needle is placed at the nerve using x-ray guidance. It is closely related to radiofrequency ablation.
Is a rhizotomy the same as radiofrequency ablation?
They are closely related. “Rhizotomy” names the goal, which is to interrupt a pain nerve. Radiofrequency ablation names the method, which uses radiofrequency heat. A facet rhizotomy is done with radiofrequency heat, so the two describe much the same kind of procedure.
Who may be a candidate for rhizotomy?
People with long-lasting neck or back pain who have tried more conservative care may be candidates. A facet or medial branch block is always done first, and your provider looks for relief from it and reviews each person’s situation before recommending it.
How long does the procedure take, and is it painful?
Your provider will discuss sedation options for your procedure at your visit. Afterward, you may have bruising, swelling and soreness at the site, which ice and over-the-counter pain medicine may help. Your team can tell you how long to plan for your visit.
What is recovery like, and when can I drive or go back to work?
You go home the same day, and you will receive aftercare instructions. Your team will tell you when you can drive and return to work. A follow-up visit may be needed to review your plan.
How long might the effect last?
Relief can last for months for some patients, but it varies with the person and the area treated. Your provider will review what to expect. Nerves can grow back, so the pain may return, and the procedure can be repeated if it helped.
What are the side effects of a rhizotomy?
Possible side effects include soreness, bruising or swelling at the treated area. Less often, there may be temporary numbness, infection, a temporary rise in pain or nerve injury. Please talk with your provider about the risks that apply to you.
Related care
Individual results are not guaranteed and may vary from person to person. This page shares general information. It is not medical advice and does not replace a visit with a qualified clinician.