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Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Lumbar Facet Rhizotomy

As early as 1911 back and leg pain have been reported to arise from articular facet joints. These are the joints in the spine other than the intervertebral disk joint. Facet denervation (rhizotomy) has been successful in relieving chronic pain arising from abnormalities of the facet joint. This is an outpatient, percutaneous procedure for patients whose pain is not related to disk herniation. Other procedures are available for patients with disk herniation.

Percutaneous facet rhizotomy was developed in 1974 by Sheeley. Patients must undergo a selection process consisting of successful nerve blocks using a temporary anesthetic injected around the nerves of the facet joint. Only patients who experience significant pain relief for several hours are considered candidates for facet rhizotomy.

The actual rhizotomy is performed using a radiofrequency generator. The radio frequency probe with a needle with an electrode at the tip is placed alongside the small facet nerves to the facet joint.   At this location the facet nerve (nerve of Luschka) is blocked by the radio frequency generator.

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