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Pain Management

Dr. Dirkx and Dr. Jacques in Combination Perform:

Benjamin Dirkx, D.O

Lumbar and Sacral Radiofrequency Rhizotomy

A lumbar radiofrequency neurotomy (or radiofrequency rhizotomy) is a minimally invasive procedure that can help significantly decrease or possibly even eliminate the pain that can occur from injured facet or sacroiliac joints. This is accomplished by "burning" the medial branch nerves (the same nerves targeted in a "medial branch block") that carry pain signals to these joints, using specially-designed needles. It is a relatively simple outpatient procedure that usually takes less than an hour to complete.

Cervical Facet Radiofrequency Rhizotomy

A cervical radiofrequency neurotomy (or radiofrequency rhizotomy) is a minimally invasive procedure that can help significantly decrease or possibly even eliminate the pain that can occur from injured facet or sacroiliac joints. This is accomplished by "burning" the medial branch nerves (the same nerves targeted in a "medial branch block") that carry pain signals to these joints, using specially-designed needles. It is a relatively simple outpatient procedure that usually takes less than an hour to complete.

Spinal Cord Stimulation

Spinal Cord Stimulation Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small device called a pulse generator is implanted in the back and sends electrical pulse signals to the spinal cord. These pulses act to disrupt the nerve signals that make you feel pain in your affected regions of the spine and limbs. It "replaces" the pain sensation with what most patients describe as a mild tingling sensation. While the treatment does not work for everyone, most patients who qualify for this stimulation therapy report a significant reduction in overall pain, as well as an increased ability to participate in normal family and work activities. Many patients find that they can decrease or stop taking painkillers or other pain medications after undergoing spinal cord stimulation. Your doctor usually will first insert a temporary stimulator through the skin (percutaneously) to give the treatment a trial run for a period of about 5 to 7 days. If the trial is successful, your doctor can implant a more permanent stimulator. After this same-day outpatient procedure is complete, you and your doctor will determine the best pulse strength and usage schedule for long-term use. For more information, see the spinal cord stimulation video link.

Epidural Injections

Epidural injections are given to relieve pain in the neck, back, arm and leg due to inflammation of spinal nerves from conditions such as spinal stenosis, spondylolysis, herniated disc, degenerative disc and sciatica. Epidural injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. During the procedure, a thin hollow needle is inserted into the epidural space. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view. Some of the complications include spinal headache, infections, allergic reactions and worsening pain. To help minimize risk please follow all directions given to you by your care provider.  Have all your treatment options explained, so you are aware of the risks and benefits of these procedures.

Medial Branch Radiofrequency Ablation:

The medial branches carry pain sensation from the facet joints to the spine and brain. Facet joints are joints between adjacent vertebral bones that provide stability to the spinal column. Wear and tear or mechanical stress may damage the facet joints, resulting in pain and inflammation.

Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique which uses the heat produced by radiofrequency waves to damage nerves transmitting pain signals to the brain.

This procedure may be performed to treat painful facet joints in the spine that usually cause chronic low back and neck pain.

Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints, by performing a diagnostic facet joint injection. The procedure is minimally invasive and administration of general anesthesia is not required. You will be conscious throughout the procedure and lying on your stomach. Only a small area over your back or neck which requires treatment is cleansed and numbed.

During the procedure, your doctor will direct special radiofrequency needle electrodes close to the affected facet joints in such a manner that the needle tip lies near the medial branch nerves. This is performed under the guidance of a fluoroscope, a special kind of X-ray machine that displays live images on a monitor. Radiofrequency energy is then used to heat the needle tip so that the nerve gets cauterized and destroyed, subsequently reducing the pain. The entire procedure may last about an hour or two.

You will usually be able to return home an hour after the procedure, but may experience some soreness at the needle sites for a few days. Using a cold pack can help relieve the discomfort. Complications are rare and include nerve damage, bleeding, infection. Radiofrequency ablation can provide effective relief for a period of 6-12 months.