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Facet radiofrequency rhizotomy

Facet radiofrequency rhizotomy is a minimally invasive procedure aimed at relieving chronic low back (or neck) pain that arises from the facet joints of the spine. It is intended for patients with mechanical pain that clearly and temporarily improves after prior diagnostic facet blocks, and in whom conservative measures are no longer enough. This guide explains in plain terms what to expect before, during and after the procedure, including how long relief typically lasts and what to do if pain returns.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Illustration of a radiofrequency electrode denervating the medial branch of the lumbar dorsal ramus under fluoroscopic guidance.

What is facet radiofrequency rhizotomy?

Facet radiofrequency rhizotomy (also called medial branch neurotomy or facet denervation) is a percutaneous, fluoroscopy-guided procedure in which heat is applied through a radiofrequency electrode onto the medial branch of the dorsal ramus. This small nerve carries pain signals from the facet joint; interrupting it reduces mechanical back pain.

Unlike facet joint blocks, which mainly serve to confirm the diagnosis, rhizotomy aims at longer-lasting relief, typically 6 to 12 months, in patients whose diagnostic blocks have been positive. To check whether your case fits, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from facet rhizotomy typically report:

Mechanical low back pain that worsens with standing, prolonged walking or extending the spine
Referred pain to the buttock or back of the thigh, usually not crossing the knee
Discomfort when getting up from a chair or twisting the trunk
Clear, though temporary, pain relief after one or two diagnostic facet blocks
Warning signs that argue against rhizotomy: leg weakness, pain radiating to the foot, bowel or bladder changes, fever or night pain unrelieved by position

When is facet rhizotomy indicated?

Chronic low back (or neck) pain lasting more than 3-6 months with a clearly mechanical pattern
Clinical suspicion of facet-origin pain after examination and imaging review (MRI or CT)
Positive response to one or two diagnostic medial branch blocks (>50-80% relief during the anaesthetic window)
Failure of an adequate course of conservative care: physiotherapy, exercise, analgesia and activity modification
No surgical indication for fusion or for decompression due to nerve compression

How is the procedure performed?

1.Preoperative preparation

Preparation includes confirming that diagnostic facet blocks were clearly positive, reviewing imaging and current medication (especially anticoagulants and antiplatelets) and answering any questions. Light fasting instructions are given, and the procedure is planned either under local anaesthesia with mild sedation or under local anaesthesia alone.

2.During the procedure

The patient lies prone on the table. Under fluoroscopic guidance the target facet levels are identified and thin cannulas are advanced onto the medial branch. Before applying radiofrequency, sensory and motor stimulation are performed to confirm correct targeting and rule out proximity to a nerve root. Controlled heat is then delivered (typically 80-90 °C for 60-90 seconds) at each level. The whole procedure usually takes 30-60 minutes depending on the number of levels treated.

3.Immediate postoperative period

After the rhizotomy the patient is monitored for a short period. Local tenderness in the treated area for a few days is common, and a temporary mild flare-up of the usual pain may occur before improvement, related to the controlled thermal lesion itself. Most patients go home the same day and resume light activity within 24-48 hours.

Recovery after facet rhizotomy

Recovery is quick. Daily activities are usually resumed the next day and office work within a few days. Intense effort and impact sports should be avoided for 1-2 weeks.

Pain relief is not always immediate: a gradual improvement over 2-4 weeks is common as the treated tissue heals. The effect typically lasts 6 to 12 months, a window that is best used for physiotherapy and core strengthening. If pain returns with the same mechanical pattern, rhizotomy can be repeated with good results.

Risks and possible complications

Facet rhizotomy is a low-risk procedure, but it is not free of complications.

The most common issues are: local discomfort or burn-like soreness at the puncture site, a transient flare-up of pain in the first days, superficial bruising and mild infection (uncommon). Rarely, temporary involvement of a nearby nerve root can cause dysesthesia or mild weakness, which is why prior stimulation is performed. It must also be accepted that in some patients relief is less than expected or shorter, or that pain returns before 6 months.

Frequently asked questions

In most patients with prior positive diagnostic blocks, facet rhizotomy provides 6 to 12 months of improvement. In some cases the effect is shorter, in others it lasts beyond a year. Nerve regeneration is what ultimately limits the duration.
Diagnostic facet blocks confirm that the pain truly originates in the facet joints. If relief with the anaesthetic is clear, the chances of success after rhizotomy increase substantially. Without that step, the procedure loses precision.
It is done under local anaesthesia, sometimes with mild sedation. During radiofrequency application you may feel warmth or pressure, but not sharp pain. Local soreness in the treated area is common in the following days and responds well to simple analgesics.
Most patients resume daily activities and office work within 1-3 days. Gentle sports can be reintroduced after a week and impact sports after 2 weeks, as long as local discomfort allows.
Yes. The treated nerve regenerates over time and, if pain returns with the same mechanical pattern, rhizotomy can usually be repeated with results similar to the first one. It is typically considered when the previous relief was clear and lasted several months.
Facet blocks are mainly a diagnostic tool and short-term treatment: the anaesthetic effect is brief. Rhizotomy aims to provide sustained relief for months once the facet origin of the pain has been confirmed.

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Fluoroscopy-guided injection that delivers corticosteroid next to a specific nerve root through the foramen to relieve radicular pain from disc herniation or foraminal stenosis.

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Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala