Rhizotomy in Manhatten

Rhizotomy at our Manhattan, NY location is a minimally invasive procedure that disrupts the nerve signals responsible for chronic facet joint pain, offering relief that outlasts conventional injections by months or years.

When Injections Work But Do Not Last, Rhizotomy Takes the Next Step

For patients with chronic neck or back pain originating from the facet joints, diagnostic injections can confirm the source and provide temporary relief. But temporary is the operative word. Rhizotomy addresses the same nerves on a more lasting basis, using precisely delivered radiofrequency energy to disrupt the pain signal at its origin rather than simply muting it with medication. At Gerling Spine Care and Research Institute, rhizotomy is an important step in the structured clinical pathway we use to manage facet-mediated spinal pain for our Manhattan patients. Contact our Manhattan office today to find out whether Rhizotomy is the right next step for you.

What Is Rhizotomy?

Rhizotomy, also known as radiofrequency ablation (RFA), is a minimally invasive procedure that uses radiofrequency energy to heat and disrupt the medial branch nerves responsible for transmitting pain signals from the facet joints to the brain. Once disrupted, the nerve can no longer carry the pain signal, providing relief that typically lasts between nine months and two years.

How Rhizotomy Differs From Injections

Facet joint injections and medial branch blocks deliver medication to reduce inflammation or temporarily block the pain signal. Their effect is limited by the duration of the medication. Rhizotomy physically disrupts the nerve itself, producing relief that does not depend on medication wearing off. For patients who have had positive responses to medial branch blocks but found the relief too short-lived, rhizotomy is the logical and clinically appropriate next step.

The Role of Prior Diagnostic Blocks

Rhizotomy is not performed without first confirming through medial branch block injections that the facet joints are the primary pain source. Most clinical protocols require two separate positive block responses before rhizotomy is recommended, ensuring the procedure is applied only to patients with the highest likelihood of meaningful benefit. This diagnostic rigor is a defining feature of how our Manhattan team approaches chronic spinal pain management.

Dr. Gerling performing a neurological reflex test on a patient

How Rhizotomy Works

Rhizotomy is an outpatient procedure performed under local anesthesia with mild sedation for comfort. The patient lies face down while the treatment area is cleaned and numbed. Using fluoroscopic guidance, a specialized needle is positioned precisely alongside the targeted medial branch nerves. A small electrical current is first applied to confirm correct placement, which typically produces a brief muscle twitch or mild sensation.

Once the position is confirmed, local anesthetic is administered, and radiofrequency energy is delivered through the needle tip, generating controlled heat that disrupts the nerve's ability to transmit pain signals. The procedure typically takes less than one hour, and most patients are home the same day.

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Conditions Treated With Rhizotomy

Rhizotomy is most appropriate for chronic spinal pain that has been confirmed through prior diagnostic injections as originating from the facet joints. It is used for patients with:

Facet joint arthropathy or osteoarthritis of the cervical, thoracic, or lumbar spine
Facet joint syndrome producing chronic axial neck or back pain
Degenerative spondylosis with significant facet joint involvement
Chronic spinal pain following whiplash or injury with confirmed facet contribution
Sacroiliac joint pain in select cases where the medial branch nerves are involved

It is not appropriate for pain primarily caused by disc herniation, nerve root compression, or other non-facet pathology.

Are You a Candidate for Rhizotomy in Manhattan?

The clearest indicator of candidacy for rhizotomy is a significant and reproducible reduction in pain following two separate medial branch block injections. Beyond that, good candidates have chronic axial spinal pain lasting three months or longer, have not achieved lasting relief from conservative care or therapeutic injections, and are in acceptable overall health for an outpatient procedure.

Our Manhattan team will review your full clinical and injection history before making any recommendation, and will not proceed to rhizotomy without the diagnostic foundation that gives the procedure its best chance of producing meaningful, lasting relief.

What to Expect From Rhizotomy in Manhattan

Rhizotomy is one of the most efficient procedures in our practice, with a straightforward recovery and a fast return to normal activity for most patients.

Before Your Rhizotomy

Your consultation will include a review of your diagnostic injection history, imaging, and symptom pattern. Our team will confirm your candidacy, explain the procedure and the radiofrequency mechanism clearly, and walk through realistic expectations for the duration of relief and the possibility of repeat treatment before any decision is made.

The Day of Your Surgery

The procedure is performed under local anesthesia with mild sedation. You will need a driver to bring you home afterward. Most patients experience mild pressure during the procedure but report minimal pain. Some temporary soreness or bruising at the treatment site is normal in the days that follow and resolves without intervention.

Recovering After Your Procedure

Most patients return to normal activities within 24 to 48 hours. Some initial soreness at the procedure site is expected as the treated area heals. Pain relief typically begins within days and reaches its maximum benefit within two to four weeks. Relief from rhizotomy generally lasts between nine months and two years. Because the medial branch nerves can regenerate over time, the procedure can be repeated if and when pain returns.

Why Choose Gerling Spine Care and Research Institute?

The value of rhizotomy depends entirely on the rigor of the diagnostic process that precedes it. A practice that recommends rhizotomy without first systematically confirming the facet joints as the pain source through properly conducted medial branch blocks is not giving patients their best chance at lasting relief. Our Manhattan team follows established clinical protocols precisely, and our broader spine expertise means we can manage the full picture of a patient's condition regardless of where the diagnostic pathway leads.

Rhizotomy Frequently Asked Questions

How long does pain relief from rhizotomy last?

Relief typically lasts between nine months and two years, depending on the individual and the degree of nerve disruption achieved. Because the medial branch nerves can regenerate over time, the procedure can be repeated when pain returns, often with similar results.

Is rhizotomy the same as radiofrequency ablation?

Yes. Rhizotomy and radiofrequency ablation are two terms for the same procedure. Rhizotomy refers broadly to any procedure that disrupts a nerve root, while radiofrequency ablation specifically describes the use of heat energy to achieve that disruption. In the context of facet joint pain management, the terms are used interchangeably.

Will I feel pain during rhizotomy?

The treatment area is numbed with a local anesthetic before the radiofrequency energy is delivered. Most patients feel mild pressure or a brief warm sensation rather than significant pain. Mild IV sedation is typically available for patients who prefer additional comfort during the procedure.

What happens if rhizotomy does not relieve my pain?

If rhizotomy does not provide the expected relief, it may indicate that additional pain generators beyond the facet joints are contributing to the patient's symptoms. Our team will reassess the clinical picture and explore alternative diagnoses and treatment strategies. Endoscopic rhizotomy may also be considered in select cases where conventional radiofrequency ablation has not produced the expected result.

Can rhizotomy be performed at multiple spinal levels in one session?

Yes. When pain originates from facet joints at multiple levels, the procedure can address several levels in a single session. This is both practical for the patient and clinically appropriate when the diagnostic blocks have confirmed facet involvement at those levels.