Percutaneous facet denervation and partial posterior rhizotomy

A classification is given of the types of pain emanating from the vertebral column and associated neural structures. Treatment should primarily be conservative, and if this is not successful surgery should be considered. If pain is still resistant to therapy after these steps percutaneous interruption of afferent stimuli by thermocoagulation may be considered. Two techniques are described. If pain is of the posterior mechanical type, a percutaneous facet denervation may be indicated, both in the lumbosacral and in the cervical area. Small diameter electrodes have been developed, rendering the procedure less painful and considerably reducing postoperative morbidity. For radicular pain confined to one segmental level the method of partial posterior rhizotomy is introduced. In this procedure a partial, selective interruption of stimuli is made in the dorsal root ganglion. The indications, selection of patients, techniques, results and complications of both methods are described. It is concluded that percutaneous facet denervation is an effective method for alleviating posterior mechanical pain. Partial posterior rhizotomy has a worth while success rate considering the fact that there is nothing else to offer to those patients. (Acta anaesth. belg., 1981, 32, 63-80).