Lumbar Rhizotomy
Long-Lasting Relief for Facet Joint Back Pain Without Surgery.
When chronic low back pain comes from arthritic facet joints, lumbar rhizotomy can provide months to years of relief through a precise, image-guided procedure. NASPI's board-certified specialists perform lumbar rhizotomy with no incisions and same-day recovery, close to home in Northern New Jersey.
Medically reviewed by Dr. Daniel M. Dorri, MD, and Dr. Christopher J. Bilbao, DO, Board-Certified Spine Surgeons
Need a Lumbar Rhizotomy?
If chronic low back pain from arthritic facet joints has not responded to physical therapy and medications, lumbar rhizotomy may offer the long-lasting relief you have been looking for, without surgery. Practice founder Dr. Daniel M. Dorri and the NASPI team perform lumbar rhizotomy using precise, image-guided techniques at our Northern New Jersey locations. As a needle-based procedure with no incisions, lumbar rhizotomy is one of the most effective minimally invasive options for facet joint pain. Expert spine care close to home.
What Is Lumbar Rhizotomy?
Lumbar rhizotomy, also called radiofrequency ablation or radiofrequency neurotomy of the medial branch nerves, is a non-surgical procedure that provides long-lasting relief from facet joint back pain. Using imaging guidance and a thin needle, your physician applies controlled heat from a radiofrequency probe to the tiny nerves that send pain signals from arthritic facet joints to the brain.
The facet joints are small paired joints at the back of each spinal level that allow the spine to bend and twist. With age, injury, or arthritis, these joints can become a major source of chronic low back pain. The medial branch nerves do nothing except carry pain signals from these joints. By disrupting those specific nerves, lumbar rhizotomy eliminates the pain signal without affecting movement, strength, or sensation in the legs.
Lumbar rhizotomy is typically performed after a successful diagnostic medial branch block confirms that the facet joints are the source of pain. The procedure itself takes about 30 to 60 minutes, requires no incisions, and patients go home the same day. Most patients experience meaningful pain relief that lasts 6 to 24 months. When pain returns, the procedure can be safely repeated.
Conditions Treated With Lumbar Rhizotomy
Lumbar rhizotomy is specifically designed to treat pain originating from the facet joints of the lower back. It is most effective when a diagnostic medial branch block has confirmed the facet joints as the pain source.
- $Lumbar Facet Joint Arthritis
- $Chronic Mechanical Low Back Pain
- $Facet Joint Syndrome
- $Post-Traumatic Facet Pain
- $Pain Confirmed by Medial Branch Block
- $Recurrent Facet Pain After Injections
If conservative treatments like physical therapy, anti-inflammatory medications, and facet joint injections have provided only temporary relief, and your diagnostic block confirms facet joint pain, lumbar rhizotomy may be the right next step. The procedure is also a valuable option for patients who want to avoid or delay spine surgery.
Benefits of Lumbar Rhizotomy
Lumbar rhizotomy offers significant advantages for patients with confirmed facet joint pain. It is one of the most effective non-surgical options for chronic low back pain and an important step in the treatment continuum between conservative care and spine surgery:
No Incisions
Needle-based procedure, no cuts.
Can Be Repeated
Safely performed again when needed.
Outpatient Procedure
Home within hours, no overnight stay.
Quick Recovery
Most patients resume activity in 1 to 2 days.
Long-Lasting Relief
Pain relief typically 6 to 24 months.
Image-Guided Precision
Fluoroscopy ensures accurate targeting.
Ready to explore your options?
How Lumbar Rhizotomy Works: What to Expect
Lumbar rhizotomy is a same-day, outpatient procedure performed under local anesthesia with sedation. It takes about 30 to 60 minutes and requires no incisions. Here is what to expect from your initial consultation through full recovery.
Before
Before the Procedure
The most important step before rhizotomy is confirming that facet joints are actually the source of your pain. Your physician will review your symptoms, examination findings, and imaging, then perform one or two diagnostic medial branch blocks. During these blocks, a small amount of local anesthetic is injected near the medial branch nerves under fluoroscopic (X-ray) guidance. If your pain significantly improves during the time the anesthetic is working, the facet joints are confirmed as the pain source and you are a candidate for rhizotomy.
You will receive instructions about which medications to stop before the procedure (typically blood thinners) and what to expect on the day of the procedure. Most patients can eat a light meal before the appointment unless deeper sedation is planned.
During
During the Procedure
Lumbar rhizotomy is performed in a procedure suite, not an operating room. You will lie face down on a fluoroscopy table. After the skin is cleaned and numbed with local anesthetic, your physician uses live fluoroscopic imaging to guide thin radiofrequency needles to the exact location of the medial branch nerves at each affected level.
Once correct needle placement is confirmed (often verified with electrical sensory and motor stimulation testing), the radiofrequency generator is activated. Each nerve is treated for about 60 to 90 seconds with controlled heat that disrupts its ability to transmit pain signals. The treatment is typically performed on multiple medial branches because each facet joint receives signals from two nerves.
The entire procedure typically takes 30 to 60 minutes depending on the number of levels treated. There are no incisions, only small needle puncture sites.
After
After the Procedure
Patients are observed briefly in the recovery area and discharged home the same day. You may experience mild soreness at the treatment sites for a few days, and the area can sometimes feel slightly numb or strange as the nerves are interrupted. Some patients have temporarily increased back pain (often called post-rhizotomy flare-up) for several days before relief begins, while others experience improvement right away.
Most patients resume light activities within 1 to 2 days. Heavy lifting and strenuous activity should be avoided for about a week. Dr. Dorri and the NASPI team will provide personalized recovery instructions and schedule a follow-up to assess your response to treatment.
Maximum pain relief typically develops over 2 to 4 weeks as inflammation from the procedure subsides. Most patients experience meaningful relief lasting 6 to 24 months. When pain returns as the nerves regenerate, the procedure can be safely repeated to restore relief.
Are You a Good Candidate?
You may be a candidate if:
- NDiagnostic medial branch block confirmed facet pain
- NChronic mechanical low back pain (worse with extension)
- NPain unresponsive to physical therapy and medications
- NFacet joint arthritis visible on imaging
- NNo radiating leg pain from nerve compression
- NLooking for non-surgical, long-lasting relief
May not be ideal if:
- Pain primarily from a herniated disc or stenosis
- Diagnostic block did not relieve pain (facets not the source)
- Active infection at or near the treatment site
- Uncontrolled bleeding disorder
- Pregnancy (fluoroscopy is used during the procedure)
Every patient is different. During your consultation, your physician will perform a thorough evaluation and always recommend the safest, most effective treatment plan for your specific condition, whether that is lumbar rhizotomy, a different non-surgical approach, or further evaluation for surgery.
Risks & What You Should Know
Lumbar rhizotomy is one of the safest interventional spine procedures available, with an excellent track record over decades of use. Like any medical procedure, however, it does carry potential risks, including:
- Temporary increase in back pain (post-rhizotomy flare-up), typically resolving in days
- Bruising or soreness at the needle insertion sites
- Temporary numbness or unusual skin sensation over the treated area
- Bleeding (rare)
- Infection (rare)
- Incomplete pain relief or shorter-than-expected duration of relief
- Need for repeat procedure as the nerves regenerate over time
- Very rare complications from radiofrequency or sedation
At NASPI, careful patient selection through diagnostic blocks, precise fluoroscopic guidance, and physician experience all work to minimize these risks and maximize the chance of long-lasting pain relief.
Ready to explore your options?
Your Spine Surgery Team
Daniel M. Dorri, MD, FABPMR
Practice Founder & Spine Surgeon
Dr. Dorri founded NASPI to provide comprehensive spine care from diagnosis through surgical treatment, all under one roof. His extensive experience means your care is guided by a surgeon who has evaluated your condition from day one.
Christopher J. Bilbao, DO,
Board-Certified Neurosurgeon
Dr. Bilbao is a fellowship-trained neurosurgeon with specialized expertise in minimally invasive and endoscopic spine surgery techniques, including robotic-assisted procedures.
Why Choose NASPI for Spine Surgery?
Experienced Surgeons
Advanced interventional spine procedure training
Complete Care
Diagnosis through recovery, one roof
Cutting-edge Tech
Latest instruments and imaging
Patient-centered
Clear communication, every step
Lumbar Rhizotomy FAQs
What is the difference between lumbar rhizotomy and a facet joint injection?
Facet joint injections place a steroid medication directly into or around the facet joint to reduce inflammation. The relief is usually temporary, lasting weeks to a few months. Lumbar rhizotomy uses radiofrequency heat to interrupt the small medial branch nerves that carry pain signals from the facet joints. Because rhizotomy targets the pain pathway itself rather than just reducing inflammation, the relief is typically much longer, lasting 6 to 24 months. Many patients move from injections to rhizotomy when injections stop providing adequate relief.
How long does lumbar rhizotomy take?
The procedure itself typically takes 30 to 60 minutes, depending on how many levels are being treated. Each medial branch nerve requires its own controlled radiofrequency lesion. Counting check-in, sedation, and recovery, plan for about 2 to 3 hours at the procedure facility.
How long does the pain relief from lumbar rhizotomy last?
Most patients experience meaningful pain relief lasting 6 to 24 months, with an average of 9 to 12 months. Relief duration varies based on individual factors. The medial branch nerves do eventually regenerate, which is why pain can return over time. When that happens, the rhizotomy can be safely repeated to restore relief, often with similar duration.
What is a medial branch block and why is it required first?
A medial branch block is a diagnostic test where a small amount of local anesthetic is injected near the medial branch nerves under fluoroscopic guidance. If your pain significantly improves during the time the anesthetic is active (usually a few hours), the facet joints are confirmed as the source of pain and you are a candidate for rhizotomy. If the block does not relieve your pain, the facets are not the source and rhizotomy would not be expected to help. The block is essential because it prevents unnecessary procedures and dramatically improves rhizotomy success rates.
Does lumbar rhizotomy hurt?
The procedure is performed under local anesthesia with light sedation, so most patients experience little to no pain during the rhizotomy itself. You may feel pressure or a brief warm sensation as each nerve is treated. After the procedure, mild soreness at the needle sites is common for a few days. Some patients experience a temporary increase in back pain (post-rhizotomy flare-up) before relief begins, which typically resolves within a week.
Will lumbar rhizotomy weaken my back or affect movement?
No. The medial branch nerves treated during rhizotomy carry only pain signals from the facet joints. They do not control muscle movement, leg sensation, or spinal stability. The procedure relieves pain without weakening your back, affecting your gait, or causing numbness in your legs.
Can lumbar rhizotomy be repeated?
Yes. The medial branch nerves do eventually regenerate, often over 6 to 24 months, and pain can return as they reconnect with the facet joints. When this happens, lumbar rhizotomy can be safely repeated. Many patients have several rhizotomy procedures over many years to manage chronic facet pain without progressing to surgery.
Can lumbar rhizotomy be done after spine surgery?
Yes, in most cases. Lumbar rhizotomy can be performed after previous spine surgery, including fusion, when residual facet joint pain is confirmed by a diagnostic medial branch block. Patients with persistent back pain after fusion (sometimes from adjacent or non-fused facet joints) may benefit from rhizotomy. Your physician will review your specific surgical history when determining candidacy.
Is lumbar rhizotomy covered by insurance?
Yes. Lumbar rhizotomy is covered by most major insurance plans when medically necessary, though pre-authorization is typically required. Most insurers require documentation of failed conservative care and at least one (sometimes two) successful diagnostic medial branch blocks confirming facet pain. Our team will work with you to verify benefits and obtain pre-authorization before scheduling. Contact us with any insurance questions.
Where can I get lumbar rhizotomy in Northern New Jersey?
NASPI offers lumbar rhizotomy at our Northern New Jersey locations, including Paramus, Clifton, Bayonne, North Bergen, Newark, and Secaucus. Contact us or call (844) 666-2774 to schedule a consultation with the NASPI team.
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What Our Spine Surgery Patients Are Saying
I found Dr. Dorri to be very detailed and complete in my surgical and follow up appointments.
He always asked how I felt and my concerns very detailed in listening to my concerns and always took time to listen to me.
I've completed my care plan with Dr. Dorri and I'm pleased with the my care and results.
Thank You Dr. Dorri
N. Hairston
I’m truly happy with the results of my surgery. My knee feels so much better, my mobility has improved, and I’m able to do things again that had become difficult before. The improvement has made a real difference in my everyday life.
What I appreciated most was not only Dr. Boiardo’s skill as a surgeon, but also the kindness and personal attention I received throughout the process. I felt that I was in very capable hands every step of the way.
I would highly recommend Dr. Boiardo to anyone needing an orthopedic surgeon. I’m very thankful for the excellent care I received and for such a positive outcome.
Insurance & Locations
NASPI accepts out-of-network benefits from most major insurance plans including Horizon BCBS, Aetna, Cigna, United Healthcare, Oxford, and more.
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We also work with workers' compensation and personal injury/no-fault cases.
*We are unable to accept Medicare, Medicaid, or OMNIA plans at this time.