Anatomy of the Facet Joint of the Spine

Dr Tim Grice

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DR TIM GRICE

INFORMATION SHEET and Consent forFacet Joint and Costovertebral/Costotransverse JointRadio Frequency Neurotomy Treatment

Thoracic Pain

ANATOMY OF THE FACET JOINT OF THE SPINE

ANATOMY OF THE COSTOVERTEBRAL JOINT

ANATOMY OF THE COSTOTRANSVERSE JOINT

Radiofrequency Neurotomy (RFN)

RFN is a procedure performed on the nerves that carry the pain signals from the facet joints. These joints may be subject to inflammation or arthritis particularly in the low back or neck and sometimes the thorax, where they can cause pain to the surrounding area. The aim of RFN is to interrupt the nerve supply to the painful joints by decreasing the pain signals being sent to your brain. This procedure does not treat the underlying arthritis in the joints. Also, this procedure does not give permanent relief from pain, as the nerves eventually recover and the pain can return. However, RFN may provide relief for 6-12 months. If the initial treatment is successful, this procedure can be repeated multiple times.

Prior to this treatment, you will need to have had a positive response to Medial Branch Block (MBB) procedure performed to the Facet joints and Costovertebral / Costotransverse Joints

The RFN procedure is performed in a similar way to the Medial Branch Block and Costovertrbral/ Costotransversejoint injections. However, this procedure –

Targets nerves close to the joint,
Takes longer to perform,
Is more technically challenging, and
Also requires multiple levels of intervention.

FACET JOINT AND MEDIAL BRANCH NERVE THAT ARE TARGETED IN RFN

INDICATORS

Neck, Thoracic, Low back pain that may spread to the back of the head, neck and shoulder and can cause headaches;
Pain in the back of the chest, by the ribs; or
Low back pain that may spread to the buttocks.

WHEN BOOKING THE PROCEDURE

On the day of booking your procedure, please advise staff if you are –

Taking blood thinners (especially warfarin and clopidogrel)- T

Diabetic
Pregnant, or any chance of being pregnant
Allergic to:

Dr Tim Grice

Shellfish
Steroids
Local anaesthetics
Iodine
Betadine
Chlorhexidine

Dr Tim Grice

Unwell or have an infection

DAY OF THE PROCEDURE

DO NOT eat or drink (for 6 hours before your procedure),
TAKE your usual medications with a small amount of water(apart from those mentioned above), and
ARRANGE for someone to accompany you home.

DURING THE PROCEDURE

After arriving you will need to complete the necessary paperwork. Then –

You will change into a hospital gown,
A small drip will be inserted into one of your veins,
You may be offered mild/moderate sedation
Your heart rate and blood pressure will be monitored throughoutthe procedure,
You will lie face down on an x-ray table, then the skin over the area to be injected will be cleaned with an antiseptic solution,
A sterile barrier will be created,
A local anaesthetic will be injected to numb the area,
An x-ray machine will be used to guide a small needle towards the nerve,
You may experience some discomfort, however this usually subsides and can be treated

with icepacks and medication.

AFTER THE PROCEDURE

You will be monitored in a recovery area until you are ready to go home. This usually takes between 60 – 120 minutes.
Preferably, someone will take you home and stay with you for the next 24 hours.
Pain may return when the anaesthetic wears off. Some people experience an initial increase in pain and stiffness, which may continue for several days. If necessary you may apply an ice pack to the area for 20 minutes at a time, for 1-2 days following the procedure.
You may take simple pain-killers, such as Paracetamol or opioids to ease any discomfort.
Remove any dressing the day after your procedure.
Avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor.
If you have received sedation during your procedure, the effects may last up to 24 hours. Due to the effects, you may not remember some of the information given to you during the procedure. For the next 24 hours, you SHOULD NOT –

Dr Tim Grice

Drive a vehicle,
Drink alcohol,
Operate machinery,
Make important decisions,
Sign legal documents, or
Travel unaccompanied

Dr Tim Grice

COMPLICATIONS

This procedure is usually safe and uneventful. However, as with any procedure there is always a small degree of risk.

Common Complications

Continuing pain / no benefit
Minor bleeding in the area injected
Bruising in the area injected
Temporary weakness or numbness from the local anaesthetic
Brief increased pain that may fluctuate in intensity

More Serious Side Effects

Damage to surrounding structures
Pneumothorax (collapsed lung)
Infection
Permanent nerve injury
Allergy to the anaesthetic drugs used as part of the procedure
Increase of any pre-existing medical condition such as cardiac conditions

Bruising around the area from needle trauma
Aspiration during sedation
Eye injury while lying prone (face down)
Serious anaesthetic / procedural complications and very rarely death
Increased lifetime risk of cancer due to X-rays exposure
Very rare risk of surgery due too injuries from the procedure

Please discuss with your doctor any other questions you may have about this procedure or this information sheet. If you agree to have the procedure, you will be asked to sign a consent form.

If you notice –

Dr Tim Grice

Any swelling from the site,
Anybleeding from the site, or
Have any other concerns,

Dr Tim Grice

Please contact your General Practitioner, Queensland Pain Clinic, or the Emergency Department of your local hospital.

Dr Tim GriceSpecialist Pain Medicine Physician

Queensland Pain DoctorSuite 4, Level 4.123 Nerang StSouthport, QLD 4215

Phone: 07 5532 0468Fax: 07 5528 3850 Email:

CONSENT

I have had time to read and I understand the information and instructions provided to me regarding the Radiofrequency Neurotomy to Facet Joints and Costovertebral Joints procedure and the possible complications as well as thepost-procedural care.

Common Complications:-Continuing pain / no benefit, Minor bleeding in the area injected, Bruising in the area injected, Temporary weakness or numbness from the local anaesthetic, Brief increased pain that may fluctuate in intensity

More Serious Complications:-Damage to surrounding structures, Pneumothorax (collapsed lung),Infection , Permanent nerve injury, Allergy to the anaesthetic drugs used as part of the procedure, Increase of any pre-existing medical condition such as cardiac conditions, Bruising around the area from needle trauma, Aspiration during sedation, Eye injury while lying prone (face down), Serious anaesthetic / procedural complications and very rarely death, Increased lifetime risk of cancer due to X-rays exposure, Very rare risk of surgery due too injuries from the procedure

I understand that I have the right at any stage to change my mind even after I have signed this document.

I have had time to ask any questions and raise any concerns I have regarding this procedure and its risks with Dr Tim Grice.

I understand that there are alternatives to this procedure including; no –treatment, medication and psychological support.

I understand that if there were any immediate life threatening Incidents happen during the procedure that they will be treated as part of the procedure.

I understand and agree that a sample of my blood can be taken and tested should a member of staff have exposure to my bodily fluids as part of the procedure.

I believe that all my questions have been discussed and answered to my satisfactionI

I understand that this is not a permanent treatment and the pain may return but repeat procedures may be a treatment option in the future.

I consent to this procedure with / without sedation (delete one option)

Patient Name: ______Date: ______

Patient Signature: ______

Doctor Name: ______

Doctor Signature: ______

CONTACT DETAILS

Dr Tim GriceSpecialist Pain Medicine Physician Queensland Pain Doctor

Suite 4, Level4, 123 Nerang St, Southport, QLD 4215

Phone: 07 5532 0468Fax: 07 5528 3850 Email:

qpdr.com.au