Correcting the Nomenclature of Medial Branch Neurotomy to Medial Branch Coagulation.

Dear Editor,

Cervical medial branch radiofrequency neurotomy and its lumbar counterpart are established, effective treatments for neck pain and back pain mediated by medial branches of the dorsal rami [1, 2]. Although the Spine Intervention Society refers to the procedure as a “medial branch radiofrequency neurotomy” [3], others use terms such as “rhizotomy” or “ablation” [4]. However, all these names are wrong.

The term “neurotomy” is erroneous for two reasons. Foremost, the suffix “otomy” means surgical incision of a structure (typically to “open” it) as in “laparotomy or craniotomy” [5], but in medial branch neurotomy the nerve is neither incised nor opened. Also, the prefix “neuro” means “nerve,” but the term “medial branch” already denotes a nerve. So, medial branch neurotomy literally means “nerve nerve cutting,” which is redundant. “Rhizotomy” originates from the Greek “rhiz” which means “root,” but no nerve root is the target for this procedure, and no nerve root is surgically incised or opened [5, 6]. Therefore, “rhizotomy” is a misnomer on both counts. “Ablation” indicates the complete removal or extinction of a specific tissue such as endometrium or cardiac conductive tissue [6]. Upon hearing this name, patients might be led to believe that, because the nerve is gone, their pain cannot return, yet the opposite is the case. The nerve that is treated is only coagulated; it can regenerate, and pain can be expected to return. So, the term radiofrequency “ablation” is not an accurate description of the procedure.

Fortunately, there is another term—“radiofrequency coagulation”—that describes the objective of the procedure. “Coagulation” indicates that heat is used to “convert a fluid or a substance in solution into a gel” [5]. Therefore, the nerve is not destroyed, removed, or eradicated by exposure to radiofrequency energy; it is only incapacitated and retains the ability to regenerate over many months.

Insistence on proper procedural names is not pedantry but the hallmark of professionalism. Our patients and others should expect that we will be as precise in our nomenclature as we are in the performance of the procedure itself.

We hope that the Spine Intervention Society might choose to refer to “radiofrequency neurotomy” as “radiofrequency coagulation” in future publications, and that all physicians who use these procedures will follow suit.