Disc Denervation

What is disc denervation?

The anatomy of the spine (and how it works) is important to understand when exploring disc denervation as a treatment option.

Your bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. Each vertebra stacks upon the other, with the facet joints of the spine connecting them. These joints have nerves running through and around them, providing sensation and movement to the rest of the body. Separating each individual vertebra are intervertebral discs that act as cushions to minimize the impact that the spinal column receives.

When any part of this structure is compromised due to disease or injury, extreme pain can result. You may feel pain in one spot or it can radiate from the disc to other areas of the body. For example, you may feel it down the leg, across the shoulders, or down the arm.

Disc denervation is a pain management procedure that treats disc pain by heating the nerve to block pain signal transmission to the brain. Using radiofrequency, the affected nerves are heated and destroyed. This modifies the nerve fibers and blocks the signaling of pain.

The pain relief from disc denervation can last anywhere from eight to 24 months. The procedure is generally recognized as safe and can be repeated when pain returns.

How can disc denervation help me?

Disc denervation can help patients who have disabling chronic pain, especially when conservative treatments have failed. It’s most useful for cases of back and neck pain.

Remember the intervertebral discs? They are designed to be soft and provide support but have a tendency to herniate (or bulge) backwards, causing irritation to the adjacent nerves. This type of disc disease is one of the most common causes of chronic neck or back pain. In fact, it accounts for approximately 10% of all lower back pain complaints.

Disc disease may be acute herniation resulting from trauma or, more commonly, chronic caused by degenerative disc disease. Degenerative disc disease occurs as discs thin and deteriorate over time. This can lead to:

• Disrupted spinal function
• Nerve impingement
• Peripheral nerve irritation

Disc denervation has several advantages when it comes to treating back and neck pain. It is a minimally invasive procedure that can provide significant relief. No hospitalization is necessary; the procedure is performed with local anesthesia and sedation. Typically, there is little post-procedure discomfort, and you can quickly resume your normal activities.

Another advantage to disc denervation is that denervation can be controlled, minimizing the risk of damaging adjacent nerves. Also, if the pain recurs, you can repeat this minimally invasive treatment.

How does the disc denervation procedure work?

Your doctor will explain the procedure and answer all of your questions before settling you on the examination table.

Using a small thin needle, your doctor will administer a local anesthetic to numb your skin and the underlying tissue underneath. With fluoroscopic guidance, a radiofrequency needle is moved to the desired location. Electrical stimulation (a mild electrical current) is initiated through the needle to replicate your disc pain. This confirms the proper location of the pain so your doctor targets the correct nerves.

When the correct nerves have been identified, the nerve supply to the disc is denervated with radiofrequency. This destroys pain-causing nerves while minimizing the effects on the surrounding structures.

Once the procedure is complete, your doctor will place a bandage over the needle entry location. The procedure typically takes less than an hour, and you are able to go home after a short observation period.

Disc denervation risks

Complications associated with disc denervation are rare. As with all surgeries and procedures there is a risk of bleeding, infection, or nerve damage.

The most common complaint is pain at the procedure site after the local anesthetic has worn off. For most patients, this is minimal and should resolve shortly after the procedure.

Disc denervation recovery

Disc denervation recovery starts with a period of rest after the procedure. If you received IV sedation, you will spend more time resting and having your vital signs (temperature, pulse, blood pressure, etc.) monitored. Otherwise, you will rest for about 15 minutes after the procedure.

Take the day of your procedure off, and have a friend or family member drive you home. Once the anesthetic wears off, you may experience a mild burning sensation or slight numbness in the area of the procedure. Many people describe this as similar to a sunburn. This should pass as you recover. An ice pack applied for 15 minutes at a time can ease this and any swelling that occurs.

Full pain relief from disc denervation can take anywhere from one to three weeks. You can begin to resume activity after the initial period of rest but let your pain levels guide you. Your doctor may recommend physical therapy, especially if your pain has significantly reduced your activity level for a long time.

References

• Principles and Uses of Radiofrequency Nerve Lesioning in Chronic Pain Control Ahmet H. Ozturk, MD CHH Pain Management Clinic Complications of lumbar facet radiofrequency denervation. Kornick C; Kramarich SS; Lamer TJ; Todd Sitzman B Department of Anesthesiology, Division of Pain Management, Mayo Clinic, Jacksonville, Florida, USA. Spine. 2004; 29(12):1352-4 (ISSN: 1528-1159)
• Lumbar discogenic pain. Disk degeneration and minimally invasive interventional therapies Kosharskyy B, Rozen D. Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Apr;42(4):262-7
• Radiofrequency denervation of the lumbar zygapophysial joints: 10-year prospective clinical audit. Gofeld M, Jitendra J, Faclier G. Pain Physician. 2007 Mar;10(2):291-300
• A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain. Oh WS, Shim JC. Clin J Pain. 2004 Jan-Feb;20(1):55-60
• Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Spine. 1999 Sep 15;24(18):1937-42