After suffering from spinal trauma following a car accident, everyday activities like walking and even standing for more than a few minutes, became a struggle for Mark Begley. As an active biker and runner, he was concerned low back pain would prevent him from making a full recovery; but thanks to Orlando Orthopaedic Center’s Daniel M. Frohwein, M.D., and the minimally invasive lumbar medial branch neurotomy (also known as a “rhizotomy”) he performed, Mark is able to bike, run and exercise again without any pain.
Mark met with Dr. Frohwein, a board certified anesthesiologist with subspecialty certification in pain management, several times to develop a treatment plan that would help him return to his active lifestyle without pain. Dr. Frohwein proposed a minimally invasive lumbar medial branch neurotomy procedure after Mark successfully completed the test nerve blocks which predicted the procedure would be beneficial for him. “The minute I was done with the procedure, short of the pain from the actual procedure itself, I felt a difference,” says Mark. Four days later, he was back to work and able to continue the healing process pain-free.
What is a Lumbar Medial Branch Neurotomy?
The joints located at the back of the spine between the vertebrae are called facet joints, and their job is to prevent excessive or irregular motion. These joints are susceptible to damage or inflammation from normal wear and tear, osteoarthritis, spinal stenosis or, in Mark’s case, severe trauma caused by an accident.
The nerves connecting these joints to the brain are called the medial branch nerves. A medial branch neurotomy is used to “disconnect” the nerves from sending pain signals to the brain and provide a long term treatment for relief of facet joint pain.
During the procedure, patients will be positioned lying face down while the injection site is numbed. The physician will use a fluoroscope, or live x-ray image to visualize the spine and pin-point the location of the affected nerves. The entire procedure is performed through a needle placed along the nerves, which run along the outside of the vertebrae. A small electrical current is used to stimulate sensations in the nerves to ensure the accuracy of the procedure. Next, the targeted nerves are numbed and a radiofrequency pulse is used to heat the tissue around the tip of the needle, creating a heat lesion on the nerve to stop the transmission of pain signals to the brain.
Dr. Frohwein explains, “Facet joint pain is a significant cause of low back pain in many individuals. It is not a diagnosis that is usually demonstrated on MRI”s or X-rays of the spine. It requires listening carefully to a patient’s symptoms of low back pain, as well as a physical examination. The test nerve blocks then provide further confirmatory information that the facet joints are the primary cause of low back pain. A lumbar medial branch neurotomy removes the obstacle of pain and can allow patients to focus their efforts on further functional restoration techniques, such as physical therapy, for a long-term solution.”
In most cases, the entire procedure only lasts about an hour and the patient can return home the same day. The effects of a lumbar medial branch neurotomy can last nine months to two years, allowing patients to introduce additional recovery techniques such as anti-inflammatory medication and physical therapy to create a healing environment for the facet joints without additional discomfort.
“In Mark’s case,” says Dr. Frohwein, “the trauma of the car accident caused damage to multiple facet joints requiring a lumbar medial branch neurotomy. We were able to help him move and exercise again without pain, ultimately returning to the active lifestyle that he loves.”
Results and Recovery After a Lumbar Medial Branch Neurotomy
A majority of patients report significant pain relief and improved mobility following the procedure and can usually begin taking additional recovery steps within three to five days.
For Mark the biggest benefit was being able to stand and walk again pain-free. “[It’s] just very simple things that a lot of people take for granted,” Mark recalls. As an extremely active runner and biker, Mark was finally able to return to the active hobbies he enjoys.
Mark was particularly grateful for the relationship he built with Dr. Frohwein throughout the healing process. “He’s one of the smartest people I’ve ever met in my life,” says Mark. “He cares about the patient. He wants to make sure that what he’s doing is right. I know he has my best interest at heart.”
Being able to simply stand and walk pain-free are just the beginning. Thanks to Dr. Frohwein, Mark can now return to work, bike and run just as he could before the accident. For Mark, there’s one word he uses to describe the results: “Unbelievable.”