Back pain often occurs as a result of wear at the discs and facets. It is due to inflammatory changes at the joints with the image of spondylarthritis. This leads to secondary muscle tension, relieving posture and the typical back pain. The symptom is known as facet syndrome. Treatment is initially with medication (such as ibuprofen or diclofenac) combined with physical therapy and local injections of the facet joints (called facet blocks, see also pain). The effect is often only temporary. If a lasting effect can be achieved, there is the possibility of facet denervation.
This has the objective to make the nerve, which transmits the pain, generated at the facets (facet joints) desolated. This interrupts the pain pathway, thus preventing the perception of pain. The actual process that leads to pain generation is not addressed by this. It is thus a symptomatic therapy (based on the symptom - pain) on the contrary to the causal therapy, which eliminates the root cause (e.g. instability).
There are several ways to facet denervation (1: chemical, 2: by icing, called cryotherapy, or 3: using electricity, the so-called thermocoagulation). When using facet denervation with thermocoagulation, a cannula is placed directly on the dorsal ramus of the spinal nerves under radiographic control. Then a needle is guided into the electrode and the nerve is motor and sensitive (feeling) irritated. These patients often feel a "tug" in their back, which shows the correct position of the needle. However, there should not be any motor or sensory (feeling) reactions in the leg. Then, the needle would be misplaced and the nerve root itself would be irritated. The needle position must be corrected in such a case. Once the correct position of the cannula was secured, a local heat of 80 ° C is produced through current flow and maintained over 90s, so that the nerve will be deserted. This procedure must be performed in 6-8 different places. Thereafter, the patients are still treated for 1 week with ibuprofen to prevent local inflammatory reactions. The effect of a facet denervation lasts about 6-12 months, sometimes even two years. Unfortunately, only rarely a permanent, i.e. lasting effect can be reached, because if the nerve is deserted laterally new “branches” sprout, similar to a tree where the branches have been cut off. The process can be repeated. Sometimes a scar forms around the nerves after repeated thermocoagulation, which thereby prevent a renewed „sprouting“ and the effect is of long duration.
Course of the facet denervation
The facet denervation takes place under sterile conditions in the X-ray room. First the optimal setting of the spine takes place, then the corresponding puncture sites are marked and anesthetized locally. That is followed by the puncture and the radiological control of the position of the needle. If this is considered to be optimal, then the sensitive and motor activity will be irritated. Is the correct position confirmed through the irritation, the nerve is then directly anesthetized, so that the patient does not feel the desolation itself and the heating starts. Finally, cortisol is applied to prevent a local inflammatory reaction. After that, the next position is faced. A total of 6-8 punctures are carried out.