New York State Medical Treatment Guidelines for Radiofrequency Ablation, Neurotomy, Facet Rhizotomy for Neck Injury in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in considering Radiofrequency Ablation, Neurotomy, and Facet Rhizotomy as interventions for individuals with Neck Injuries. These directives aim to support physicians and healthcare practitioners in determining the appropriateness of these procedures as part of the comprehensive care plan for neck injuries.

Healthcare professionals specializing in Neck Injuries can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the potential utilization of Radiofrequency Ablation, Neurotomy, and Facet Rhizotomy for their patients.

It is crucial to emphasize that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding these interventions for neck injuries should involve collaboration between the patient and their healthcare provider.

Radiofrequency Ablation, Neurotomy, Facet Rhizotomy for Neck Injury

The procedure involves denervating the facet joint by ablating the corresponding sensory medial branches, typically using continuous percutaneous radiofrequency. Radiofrequency medial branch neurotomy is recommended as the preferred procedure, surpassing alternatives like alcohol, phenol, other injectable agents, or cryoablation. Fluoroscopic guidance is essential for precise positioning of the probe, and permanent images should be recorded to document the appropriate placement of the device.

It is recommended for patients with confirmed facet joint pain, particularly those for whom two diagnostic medial nerve branch blocks have proven therapeutically successful. However, it’s important to note that this procedure is not recommended for involvement of more than three facet joints (four medial branch nerves).

All patients should exhibit a successful response to a diagnostic medial nerve branch block and a separate comparative block for the procedure to be considered positive. A positive diagnostic block is characterized by the patient reporting a reduction of pain of 50% or greater from baseline for the duration appropriate for the local anesthetic used, coupled with functional improvement. The patient should identify impeded activities of daily living, potentially involving measurements of range of motion, due to their pain. The provider should observe and document functional improvement in the identified activities in the clinical setting.


Post-Procedure Therapy

After the procedure, it is recommended to initiate a gentle reconditioning program within the first week post-procedure, unless complications arise. Additionally, it is advisable to provide instruction and encourage participation in a long-term home-based program. This program should include activities such as range of motion exercises, strengthening of cervical, scapular, and thoracic muscles, postural or neuromuscular re-education, and endurance and stability exercises.

In terms of frequency, it is suggested to have four to ten visits post-procedure to ensure proper guidance and support in the recovery process.


Repeat radiofrequency neurotomy (or additional level radiofrequency neurotomies

It is recommended to consider repeat radiofrequency neurotomy in select patients who experience recurrent pain after enjoying 6 to nine months of relief from a prior procedure. Before proceeding with a repeat radiofrequency neurotomy, it’s advisable to conduct a confirmatory medial branch injection if the patient’s pain pattern differs from the initial evaluation.

The suggested frequency for this procedure is twice per year, based on improvements in pain and function as indicated by the patient’s response to the treatment.

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