What is a percutaneous neurotomy?
Percutaneous essentially means to pass or take effect through the skin. Where neurotomy is a severing of a nerve to produce loss of nerve transmission. The procedure in pain management, also known by terms such as rhizotomy or neuroablation, is used to provide pain relief by altering the transmission of pain signals passing through the nerve.
The procedure involves transmitting energy through a specialised needle that alters the temperature of the needle tip. The needle tip is placed adjacent to the targeted area (usually a nerve). This can then reduce the transmission of pain signals in the nerve being targeted.
What conditions can it be used for?
A neurotomy is typically completed after a positive diagnostic injection into the area has not given sufficient relief or has not responded to other treatment methods.
There are numerous pain conditions that can benefit from a percutaneous neurotomy. Some of the more common ones include:
- Spinal pain from facet joint arthritis or degenerative discs
- Migraines and headaches
- Osteoarthritis affecting other joints such as knees, shoulders, hips, and ankles
- Nerve conditions such as pudendal neuralgia, trigeminal neuralgia and cluneal neuralgia
Are there different types of percutaneous neurotomy?
There are various ways a neurotomy is completed, but in pain management they are all minimally invasive day procedures. There are generally three types of percutaneous neurotomy, each with their own advantages and disadvantages. This will have been discussed with you prior to your procedure and the type chosen will often depend on the condition being treated.
- Thermal: involves heating the needle to between 80-90ºC with the intention of disrupting the nerve to stopping the transmission of pain signals
- Cryogenic: disrupts nerve signalling by freezing. Cryogenic neurotomy does not involve electrical energy, but rather the passage of pressurized gases to freeze the needle tip.
- Pulsed: the needle is heated to a lower temperature (not above 42ºC) by passing short bursts of electrical current. Pulsed neurotomies don’t damage the nerve, but rather desensitise it by modulating the way the pain signals are being transmitted.
In general, pulsed neurotomies are often chosen in those nerves that we do not want to damage (for example, if there is a motor supply in that nerve) and/or there is a significant risk of flare up that can happen with thermal neurotomy.
How effective is a percutaneous neurotomy?
The effectiveness of a neurotomy procedure does depend on the condition being treated, the type of neurotomy and it does vary from patient to patient. It is difficult to predict your outcome before the procedure.
In general, cryogenic and thermal neurotomies can provide longer lasting relief, than pulsed, in some cases patients have seen benefit for up to 2 years. Pain tends to recur as nerves can regenerate into the painful area and may explain why any successful outcome is not lifelong. Pulsed neurotomies tend to be of shorter duration, but between 6-9 months relief is possible.
It is important to recognise that a percutaneous neurotomy is not a cure for your condition(s). However, if there is at least 6 months of relief from a percutaneous neurotomy than it is a procedure that can be safely repeated.
Like other pain procedures percutaneous neurotomies should be looked as a symptomatic treatment for your pain condition. It can be used to facilitate a reduction in medication and improve quality of life and functioning. Any improvement to pain seen can be used to facilitate a rehabilitation approach to your management as guided by your treating doctor.
What is involved in a percutaneous neurotomy?
Percutaneous neurotomies are a minimally invasive procedure that is completed in a clean operating theatre environment. It is usually completed as a day procedure and usually does not take more than 40 minutes. Throughout the entire procedure your heart rate, blood pressure and oxygen levels will be monitored. In addition to your doctor there will be an anesthetist who will monitor your care during the procedure.
- You will be given a sedative through a drip to relax you so that you are not aware of the procedure (this is not a general anesthetic).
- The procedure is completed under x-ray guidance to help direct the needle involved in the injection.
- The procedure may also involve injecting a special dye to confirm the correct location of the injection.
- The area to be targeted will be cleansed with an antiseptic solution. A local anesthetic will be injected in the treatment area before the neurotomy needle is inserted to help numb the skin.
- A small amount of anesthetic and steroid is sometimes added after the neurotomy to help reduce the risk of any pain afterwards.
Are there any risks?
The risk of complications with percutaneous neurotomies are low. There are risks associated with the procedure, medications used and the anaesthesia. For risks relating to the anaesthesia we recommend discussing this with your anaesthetist. Potential risks include:
Common (usually mild and self-limiting)
- Bleeding at the injection site
- Bruising and discomfort at the site of injection
- Pain, usually described as burning
Uncommon
- Steroid effects: elevated blood sugar levels, sleep disturbance, mood changes, facial flushing, sweating
- Headaches
- Nausea and/or vomiting
- Worsening of your pain or ineffective
Rare
- Nerve or spinal cord damage
- Infection
- Bleeding around the spinal cord
- Allergic reaction to medications
Is a percutaneous neurotomy right for you?
If you think a percutaneous neurotomy may be right for you talk to your doctor about it. If you would like any further information or would like to see one of our doctors please do not hesitate to contact Anodyne.