A facet thermal ablation or radio frequency ablation is a state-of-the-art spinal procedure that may be recommended to treat advanced arthritic degeneration in the neck or lower back. Reserved for individuals who have exhausted all of their nonsurgical treatment options, a facet thermal ablation represents a compelling alternative over spinal fusion surgery and other open spine operations that require a hospital stay and lengthy recovery.
A facet thermal ablation is an endoscopic treatment for individuals who suffer from a degenerative spine condition known as facet disease – a form of osteoarthritis in the spine. As an individual grows older, the anatomical elements in the spine will naturally begin to deteriorate. It is this deterioration that explains the marked loss of flexibility and stiffness that is commonly associated with aging. One of the components of the spine that is particularly susceptible to degeneration is the facet joints. These hinge-like structures are responsible for connecting adjacent vertebrae and stabilizing the spinal column, while also allowing for the full range of motion that we expect from our back and neck. In order to serve these dual roles effectively, each joint is coated in a thin layer of cartilage and encapsulated with lubricating fluid that allows the bones to articulate against one another comfortably. The problem is that years of wear and tear can cause this cartilage to gradually wear away, which eventually may lead to arthritic inflammation, the formation of bone spurs, and the subsequent irritation of the small nerve that exists within each joint.
While facet disease can certainly account for noticeable soreness or stiffness near the joint, the symptoms that lead most people to seek medical attention actually arise from nerve compression. It is this irritation that leads to chronic pain that can have a significant impact on an individual’s quality of life. For these patients, the problem has less to do with the degeneration of the spinal canal as it does with neural compression, which is where a facet thermal ablation comes in.
Spinal arthritis – and all types of arthritis for that matter – cannot be cured, at least not in the traditional sense. Unfortunately, the loss of cartilage in the joints is permanent and it cannot be regenerated or replaced. However, this does not mean that someone with facet disease is resigned to a lifetime of pain or discomfort. It just means that treatment will be less concerned with the condition itself as it is with treating the patient’s symptoms. With the proper approach, degeneration can be slowed, joint mobility maintained or improved, and pain sufficiently managed or mitigated.
When an individual is first diagnosed with facet disease, a number of nonsurgical treatments will be attempted to alleviate the nerve compression. However, for a limited segment of the population, this regimen may prove ineffective, and the prospect of a decompression procedure becomes more likely.
What to Expect from the Actual Procedure
The procedure begins with the patient being administered deep IV sedation, as opposed to the general anesthesia that is typically used in open spine surgeries. The use of deep IV sedation greatly reduces the post-operative recovery process, limits the risk for anesthesia-related complications, and is easier on the patient. Once the patient is sufficiently sedated, only a small incision is required in order for the team of orthopedic surgeons to have sufficient access to the problem area in the spine. In most instances, the incision will be less than an inch long and is made posteriorly, which is to say the surgeon will access the spine through the back, not through the front of the body. The size of the incision is one of the biggest differentiators between an endoscopic procedure and open spine surgery because of the requirements of the surgical site. When an individual consents to spinal fusion, for example, an incision of several inches must be made because the surgeon needs to be able to access the spinal column, insert instrumentation, grafts, and hardware, and perform the operation. With an endoscopic treatment, the surgical site only needs to be large enough to insert a tube that will navigate into the spinal column and allow the insertion of a very small camera known as the endoscope, a highly advanced laser, and any other surgical tools the surgeon may require. This distinction is important because the nature of an endoscopic procedure allows soft tissue, such as musculature, to be gently pushed aside, not severed. By taking this approach, the time and intensity of recovery and rehabilitation is greatly reduced and there is significantly less damage to the area surrounding the spinal column than with other surgeries.
After the incision is made and the tube is in place within the facet joint, the goal of the procedure is quite simple. The source of the patient’s pain is the irritation of the small nerve that serves only to detect arthritis in the vertebral joint. In order to alleviate the pain from spinal degeneration, the doctor uses a laser to vaporize the nerve in the joint with thermal heat. By removing the body’s ability to detect pain in the joint, the patient’s symptoms should abate. The joint may also be cleaned of anatomical debris and depending on the specific prognosis, bone spurs may be removed and other adjustments may also be made.
Once the procedure is concluded, the surgical tools are removed and the incision is closed with absorbable sutures or surgical staples. The patient is then transferred to the recovery area, where they are typically kept for an hour or two while the effects of the IV sedation wear off and the patient regains complete lucidity. After this brief period, the patient is given basic information on keeping their incision clean and given information on the post-operative recovery period.
The appeal of a facet thermal ablation, and endoscopic spine procedures in general, is that they are minimally invasive and much less risky compared to the sacrifice required with an open spine operation.
As with any spinal procedure, the facet thermal ablation should only be considered after all conservative treatment measures have been exhausted.
At AOMSI diagnostics, we provide the most accurate spinal imaging available in the healthcare marketplace. This imaging has been proven in peer-reviewed medical journals to be the most accurate, reliable and specific spinal imaging when compared to traditional spinal imaging modalities.
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