In this procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain.
The terms radiofrequency ablation and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy.
There are two primary types of radiofrequency ablation:
– A medial branch neurotomy (ablation) affects the nerves carrying pain from the Facet Joints
– A lateral branch neurotomy (ablation) affects nerves that carry pain from the Sacroiliac Joints
These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs, so a heat lesion poses little danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.
Medial Branch/Lateral Branch Nerve Block
Before the radiofrequency ablation procedure, a lateral branch or medial nerve branch block will have already been performed to prove that the patient’s pain is being transmitted by those nerves. The medial branch or lateral branch block acts as a test run before the neurotomy procedure.
Additionally, a sacroiliac joint injection, facet joint injection, or other treatment methods will usually already have been attempted.
Radiofrequency Ablation Success Rates
Success rates vary, but typically about 30% to 50% of patients undergoing this procedure for low back pain will experience significant pain relief for as much as two years. Of the remaining low back pain patients, about 50% will get some pain relief for a shorter period.
Some patients do not experience any relief from pain as a result of this procedure.
Overall, success rates are greater in the cervical spine (neck) than in other areas.
As a general rule, if effective, the ablation will often provide pain relief lasting at least 9 to 14 months and sometimes for longer. After this period of time, however, the nerve will regenerate and the pain may return.
Joints Treated with Radiofrequency Ablation
Joint arthritis, degeneration, or injury can lead to spine pain and limited range of motion. The joints treated with radiofrequency ablation are:
- Facet joints – pairs of small joints that are situated at each vertebral level in the back of the spine. Each facet joint is connected to 2 medial branch nerves that carry signals (including pain signals) away from the spine to the brain.
- Sacroiliac joints – joints located at the lowest part of the spine, between the sacrum and ilium in the pelvis, and are connected to lateral branch nerves that carry signals to the brain.
The radiofrequency ablation procedure is designed to treat lower back pain originating from either facet joint or sacroiliac joint problems.
Radiofrequency ablation is a minimally invasive procedure that is usually performed with local anesthetic and mild sedation.
As with many spinal injections, radiofrequency neurotomy is best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve or other injury).
Radiofrequency Ablation Steps
The neurotomy or ablation procedure includes the following steps:
- An intravenous (IV) line is often started so that relaxation medicine (sedation) can be given.
- The patient lies on a procedure table and the skin over the neck, mid-back, or low back is well cleaned.
- The physician numbs a small area of skin with numbing medicine (anesthetic), which may sting for a few seconds.
- The physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial or lateral branch nerves.
- A small amount of electrical current is often carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the neck or back
- The targeted nerves will then be numbed to minimize pain while the lesion is being created.
- The radiofrequency waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve’s ability to send pain signals.
- This process will be repeated for additional nerves.
During the one to four days following the procedure, the area treated – the patient’s neck or back – will usually be sore. This pain is usually caused by muscle spasms and irritability while the targeted nerves are dying from the heat lesion. This process of the nerves dying usually takes about 7 – 14 days.
Radiofrequency Neurotomy (Ablation) Side Effects
There are several potential side effects following a radiofrequency (ablation) procedure, including:
- Depending on the area treated, patients might develop a superficial burning pain with hypersensitivity, similar to a sunburn feeling, over the treated area that lasts for 1 – 2 weeks
- Following this superficial pain, some patients might also experience a light numbness of the skin over the same area
- The physician may give medicine to the patient to treat the expected soreness, and the physician may also instruct the patient on how to apply ice (or heat or warm towels) to the sore area to alleviate discomfort
- On the day after the procedure, the patient may cautiously return to regular activities
- Patients usually will want to rest for several days before returning to normal activities, although there are not any technical restrictions. Patients are allowed to engage in normal activity, but should let pain levels be their guide for the first few days
- Since many patients have been de-conditioned over many months or years as a result of their pain, their physicians might prescribe a guided physical therapy regimen to allow them to increase their strength and activity tolerance in a safe manner.
As with all medical procedures, there are certain risks and potential complications associated with a radiofrequency neurotomy.
Complications are rare with this procedure, but can occur, and include:
- Pain or discomfort around the area treated
- Numbness of skin covering the area treated
- Worsened pain due to muscle spasm in the area treated
- Permanent nerve pain
- Allergies or reactions to medications used
Although not a complication, the biggest side effect of the procedure is the transient sunburn type pain. For most patients this pain is not severe, however, in 3 – 5% of patients the pain is quite troublesome and will last for several weeks. It is less common in the mid and low back than in the neck, and is most common at higher levels of the neck. This side effect is believed to be from increased irritation of a nerve that was only partially damaged, not completely destroyed. This effect can be treated with topical medication or oral medications.
Patients are frequently concerned that, without the ability to feel sensation through the treated nerves, they may cause an injury to either the joints or the back. There is no scientific evidence to support this concern. In fact, in the many years that neurotomies have been performed, patients have not been found to be at any increased risk of injury.
Lumbar Radiofrequency Neurotomy Video
A lumbar radiofrequency neurotomy (or radiofrequency ablation) is a minimally invasive procedure that reduces or eliminates the pain from damaged facet or sacroiliac joints by disrupting the medial branch nerves that carry pain signals. This animated video provides a clear picture of a lumbar radiofrequency neurotomy.
A radiofrequency neurotomy is a type of injection procedure used to treat facet joint pain.
Facet joints are pairs of small joints between the vertebrae in the back of the spine. The facet joints support the spine while also allowing motion in terms of bending, flexing and twisting. Each facet joint is connected to two small medial branch nerves that carry pain signals from the facet joints to the brain.
A number of spinal conditions can lead to facet joint pain, such as osteoarthritis and spinal stenosis, or from a trauma to the back, such as a car accident.
A radiofrequency neurotomy – also called radiofrequency ablation – begins with the patient laying face down on a table. The skin and tissue over the procedure site is numbed with an injection of local anesthetic.
Next, the physician uses x-ray guidance, called fluoroscopy, to direct a special radiofrequency needle alongside the medial nerves.
Often, a small amount of electrical current is carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the back.The targeted nerves will then be numbed with a local anesthetic to minimize pain.
The radiofrequency waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve’s ability to send pain signals to the brain.
As with many spinal injection procedures, radiofrequency neurotomy works better for some patients than for others. It is often helpful in reducing a patient’s pain enough to participate in a rehabilitation program.
Cervical Facet Radiofrequency Neurotomy Video
This minimally invasive procedure, also known as a Radio Frequency (RF), reduces or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals.