Overview

The spine is a column of bones (vertebrae) arranged on top of each other. The bones are linked at the back, by joints called facet joints. There is one on each side of each vertebra. The facet joints hold the bones together and stabilise the spine, while also allowing movement.

The facet joints might become painful due to normal wear and tear (degenerative change), stress, or injury. Sometimes the reason is not clear. Pain is felt around the facet joints and in the surrounding area. For example, pain starting from the joints of the lower back will often be felt in the buttocks (bottom) and upper legs.

When the facet joints are tender and sensitive, the muscles nearby can tighten to protect them. When this continues for some time, this also becomes painful.

How facet joint denervation works

Facet joint radiofrequency denervation is a procedure where nerve fibres that supply the painful joints are deliberately destroyed by heat. The heat is produced by radio waves and given using a needle (radiofrequency probe). When a radiofrequency current is passed down the probe, a very small amount of heat breaks the nerve. This procedure does not affect any other part of the body.

The treatment is usually done after an injection of local anaesthetic close to the affected joints. 

Several treatments to different areas of the body can be given during one procedure.   

The aim of the treatment is to reduce pain coming from the joints in the lower back. This will hopefully help to reduce spasm in the muscles, improve mobility and reduce stiffness. It should give longer-lasting pain relief compared to a simple anaesthetic injection. You can read our information about facet joint radiofrequency denervation.

Risks of having denervation

Facet joint denervation is a common procedure and is generally safe and effective. However, no procedure is risk free, and facet joint denervation has a small risk of these side effects or complications.

• A skin infection where the needle is inserted, causing symptoms such as redness or swelling (this happens in 1 in 1,000 patients).
• Bleeding or bruising at the injection site.
• Temporary numbness or weakness from the local anaesthetic that is injected during the procedure. This usually improves in 2 to 3 hours. This can affect your back and limbs, and you might need to stay in hospital overnight (although this is rare).
• Allergy to injected medicines (this happens in 1 in 40,000 patients).
• Nerve injury which can cause temporary numbness or weakness (this happens in 1 in 1,000 patients and usually gets better in days or weeks).
• Permanent nerve injury to a nerve supplying the leg or trunk (this is very rare, and only happens in 1 in 30,000 patients).
• Stiffness and soreness for a few days after the treatment. This can last for 2 weeks. You should take your regular painkillers and do gentle stretches.

You might become faint during the procedure, but you'll be monitored at all times, and treated immediately if you feel unwell.

Denervation under endoscopy

Facet joint denervation under endoscopy is a different way of doing the procedure, but the aim is the same. 

The main difference is that an endoscope (thin metallic tube with a video camera at one end) is used to identify the right nerves. This means that the heat treatment can be delivered several times, until we see that the nerve is destroyed. Also, as we can see the nerves we are working on, patient feedback is not needed during the procedure. This means it can be done under general anaesthetic or deep sedation.

The pain relief from this approach might last much longer compared to the traditional (done without endoscopy) procedure.

Extra risks due to the endoscopy

In general, the additional risks of an endoscopic facet joint denervation are related to:

• the anaesthetic. The treatment will be done when you are asleep under general anaesthetic, which can have additional risks. Read more about having an anaesthetic.
• the size of the endoscopic tools. The larger instruments used in an endoscopy might cause more pain after surgery. You might need an overnight stay to keep your pain under control.

As nerve testing is not possible under general anaesthetic there is also a very small chance of damaging the major nerves that leave the spine. This is slightly higher than with the traditional procedure, but is still rare (less than 1 in 100 patients).

Other treatment options

The alternative to the endoscopic approach to facet joint denervation is the conventional technique, done without endoscopy. Read our information about facet joint radiofrequency denervation.

The denervation procedure is usually used after trying less-invasive treatments, such as:

• medicines
• physiotherapy
• transcutaneous nerve stimulation (TENS)

Exercise, acupuncture, yoga, Pilates and relaxation therapy might also help ease back pain. Spine surgery could also be considered in selected cases.

Consent – asking for your permission

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you'll be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

During the procedure

Endoscopic facet joint denervation can usually be done as a day case procedure. This means you won’t have to stay in hospital overnight. It usually takes 60 to 90 minutes.

The number of joints treated, the expected pain levels after surgery, and your health are all factors which might mean you need to stay in hospital overnight. 

When you're admitted you'll see a doctor who will mark the site of the surgery and ask you to sign the consent form. The anaesthetist might also review your fitness for surgery and finalise the planned anaesthetic option. You'll then be taken to the operating theatre.

We will ask you to lie on your stomach on a special mattress. This position helps to open up the space between the bones in your spine. When the anaesthetic has been given, we will use an X-ray machine to locate the areas to be treated.

The surgeon will make small cuts (incisions) on your skin. After your procedure, your doctor will close the skin with stitches (sutures). Local anaesthetic might be applied to the operated area to relieve pain. You'll have a small dressing on your back. The stitches will dissolve over time so do not need to be taken out.

After the procedure

You'll be taken to the recovery area to be monitored. You will then be transferred to our surgical day unit or, if you're staying overnight, to a hospital ward.

You can sit up and move around when you feel comfortable and confident. If you have any concerns about your walking, numbness, or controlling your bladder or bowel, please tell a member of staff.

You should expect to have some tenderness at the operation site, which will last for up to 3 days. You might have more back pain at first, but this will settle down with time. We'll give you painkillers if you're staying in hospital, but let us know if you are still in pain.

You'll need to arrange for a responsible adult to collect you from hospital, preferably in a car. Travel on public transport is not recommended.

After you leave hospital

It's essential that you continue to take painkillers as advised after your surgery. Your pharmacist and nurse will discuss these with you before you leave.

The dressings need to be kept on until your GP practice nurse checks your wounds, 7 days after the procedure. When this has happened, you can have a bath or shower as normal without the dressing. Until the wound has been checked, you should only have a shower, and not have a bath.

Bending and lifting should be avoided for 1 to 2 weeks. You can generally get back to light work after a couple of days, and can do heavier work and sports after 2 to 3 weeks. This will depend on the nature of your job.

You are usually safe to drive within 2 to 3 days, but you must feel confident to do an emergency stop, and not be taking any sedative medicines, such as morphine-based painkillers.

You might be referred for physiotherapy. Physiotherapists will teach you exercises to help tone and control the muscles that stabilise the lower back. If you've been referred to physiotherapy, you should expect to have an appointment 4 to 6 weeks after your surgery.

If you're going to have physiotherapy at your local hospital and have not heard from them about an appointment, please contact your GP.

If your pain does not settle within 4 to 6 weeks, we can discuss it at your follow-up appointment, or you can contact your GP for advice and pain management.

Follow-up appointment

You'll be seen by a doctor or specialist nurse, 6 to 8 weeks after your procedure. We'll send you an appointment letter, but if you have not heard from us within 4 weeks after leaving hospital, please contact us.