Health technology reviews

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Facet neurotomy

Status: Decision completed

View findings and decision

Policy context

Facet neurotomy aims to treat pain resulting from facet joint disease, but it does not cure the condition. There are significant questions related to the diagnosis and treatment of facet joint pain including if it is safe, effective and cost-effective and the most effective means of identifying patients who may benefit.

Primary criteria ranking

  • Safety = High
  • Efficacy = Medium
  • Cost = Medium

Assessment timeline

  • Draft Key Questions Published: August 2, 2013
  • Public Comment Period: August 2 - August 16, 2013
  • Draft Report Published: December 19, 2013
  • Public Comment Period: December 19 – January 27, 2014
  • Final Report Published: February 24, 2014
  • HTCC Public Meeting: March 21, 2014

Background

A large proportion of the adult population suffers from back or neck pain at some point in life. One of the possible sources of chronic back pain is degeneration of the facet joints. Typically, facet arthropathy (joint disease) develops progressively and the typical patient is over 50 years of age. Whiplash injuries can also result in cervical facet joint pain. It is estimated that the prevalence of facet joint pain is 10-15% in the low back, 40-50% in the mid-back, and 45-55% in the neck. However, these estimates vary widely with diagnostic methodology employed, with reported estimates ranging from less than 5% to greater than 90%.

The primary symptom suggestive of facet joint pain is paraspinal tenderness at the affected facet joints. Other symptoms, (e.g., radiating pain, pain that is exacerbated with certain movements) may also be present and suggestive of facet joint pain. There is no "gold standard" diagnostic tool for facet joint pain. Diagnosis of facet joint pain cannot be accurately made by physical or radiological examination alone and diagnostic nerve blocks may be the most accurate assessment method. Diagnostic medial branch blocks or intra-articular injections involve injection of local anesthetic into the facet joint(s) that are believed to be the source of the pain. A positive block occurs when the patient experiences pain relief that lasts as long as the duration of action of the anesthetic used.

Once the facet joint is determined to be the source of pain as indicated by a positive diagnostic block, then prolonged pain relief may be achieved with destruction of the nerves to the affected joint in a procedure called facet neurotomy. Neurotomy does not cure the source of pain, but instead cuts off the pain signal from the brain by damaging the nerve. Different types of facet neurotomy are available, but the most common type employs radiofrequency needles to destroy the nerve tissue with heat generated by an electric current. During this procedure, the skin is anesthetized with a local anesthetic and the radiofrequency needles are advanced using guidance to confirm that the needles are properly positioned at the affected nerves. A radiofrequency current is then applied to disrupt the ability of the nerves to transmit pain signals to the brain. Other names for this procedure include percutaneous radiofrequency denervation, nerve ablation, neurolysis, medial branch neurotomy, medial branch rhizotomy, and articular rhizolysis.