Neurotomy is a specialized medical procedure designed to manage chronic pain that has not responded to conservative treatments like medication or physical therapy. The technique involves the destruction or inactivation of specific nerve fibers to provide long-term relief by permanently altering the nerve’s ability to communicate sensation. The procedure is often called nerve ablation or radiofrequency ablation, reflecting the most common method used today.
How Neurotomy Relieves Pain
Neurotomy provides relief by interrupting the communication pathway between a pain source and the central nervous system. The procedure targets small sensory nerves, preventing the electrical impulse signaling pain from reaching the spinal cord and, ultimately, the brain.
The goal is to disable the pain-transmitting capacity of the nerve while preserving motor function and other sensation. Before the procedure, specialists confirm the nerve is the source of discomfort using a diagnostic nerve block. This trial injection of a local anesthetic temporarily numbs the suspected nerve; if the patient experiences significant, temporary relief, it confirms the targeted nerve is the pain generator.
Neurotomy is commonly indicated for chronic pain originating from joints, such as the facet joints in the spine or the sacroiliac joints in the pelvis. Conditions like facet joint arthritis, which causes persistent low back or neck pain, are often treated with this technique. Disabling the medial branch nerves that innervate these specific joints can substantially reduce discomfort, managing the pain associated with the underlying condition.
The Different Methods of Neurotomy
The destruction of the targeted nerve can be achieved through various methods, categorized by the type of energy or substance used. The most common technique is Radiofrequency (RF) Neurotomy, also known as radiofrequency ablation (RFA). This method uses an alternating electrical current delivered through a needle electrode to generate heat, creating a thermal lesion on the nerve tissue.
RF neurotomy has several variations:
- Continuous (thermal) RF, which uses sustained heat to destroy the nerve.
- Pulsed RF, which delivers brief, high-voltage energy pulses, keeping the temperature lower (around 42°C) to modulate nerve function without causing complete destruction.
- Cooled RF, a newer approach that circulates water through the electrode tip to create a larger lesion size, potentially increasing the likelihood of successful nerve ablation.
Chemical Neurotomy
Chemical Neurotomy uses neurolytic agents like phenol or alcohol to destroy nerve tissue. This method is often reserved for severe chronic pain, such as that caused by cancer, where other options have failed.
Surgical Neurotomy
Surgical Neurotomy involves physically cutting the nerve fibers, a technique known as rhizotomy. This is generally reserved for highly specific conditions like trigeminal neuralgia or for managing neuroma formation following a traumatic injury.
Patient Experience During the Procedure and Recovery
Radiofrequency neurotomy is typically performed as a minimally invasive, outpatient procedure. Patients are usually asked to fast for several hours beforehand and may receive mild intravenous sedation. The process begins with the patient lying on a procedure table, and the targeted skin area is sterilized and numbed with a local anesthetic.
A specialized X-ray machine called a fluoroscope is used to guide the thin needle electrode near the targeted nerve with precision. Before applying heat, the physician performs a test by sending a small electrical current through the needle. This causes a brief tingling sensation or muscle twitch, confirming correct placement near the sensory nerve and ensuring safe distance from motor nerves.
Once confirmed, a local anesthetic is injected through the needle to numb the nerve. The radiofrequency current is then applied for a short duration, usually about 90 seconds per nerve. The entire process takes approximately 30 to 60 minutes. Immediate recovery is quick, with most patients discharged home the same day, though driving is prohibited due to the sedation.
Long-Term Outcomes and Potential Complications
The primary long-term outcome of a successful neurotomy is a significant reduction in chronic pain, which typically lasts from six to eighteen months, sometimes longer. The duration varies because nerves have a natural capacity to regenerate, meaning pain signals may eventually return as the nerve tissue regrows.
If the pain returns, the procedure can safely be repeated, as the goal is a therapeutic window of relief rather than a permanent cure. While neurotomy is considered safe, potential complications exist. Following the procedure, patients may experience localized soreness at the injection sites or a temporary “sunburn-like” sensation in the treated area for a few days to a couple of weeks.
Less common risks include temporary numbness or tingling in the treated nerve’s distribution. Temporary muscle weakness can occur if a motor nerve is inadvertently affected, though this is rare due to the electrical stimulation testing performed during the procedure. Other rare complications include infection at the injection site or neuritis (increased nerve pain or sensitivity).