Radiofrequency Ablation Procedure

You may be a candidate for a Radiofrequency Ablation if you have spinal injury or arthritis in your spinal joints. Checking if you’re a candidate for RFA is a three part process that involves two tests to be performed to see if you are indeed a candidate. The tests are called Medial Branch Blocks or MBB for short. If you respond favorably to the MBB’s then you are a candidate for the Radiofrequency ablation treatment.

What is a medial branch block (MBB)?

Medial branch nerves are very small nerve branches that carry the pain message from the facet joints and the muscles around the joints. If the nerves are blocked or numbed, they will not be able to transfer the pain sensation from the joints to the brain.

Where are facet joints?

The facet joints are small joints in the back of the spine that form connections between each vertebra. Each vertebra has a surface on four facet joints, two on the upper or superior surface and two on the lower or inferior surface of the vertebrae. The facet joints limit how far you can twist or bend your back and neck.

What if a medial branch block doesn’t work?

This is a diagnostic procedure. This injection is done to confirm the diagnosis of facet joint disease and to find out if the facet joints are contributing to your pain. If the MBB doesn’t work, then we can rule out facet joints as a cause for pain.

What medicine is injected in a MBB?

We inject a local anesthetic.

What are the risks and side effects?

Serious side effects and complications are uncommon. The most common problem after the injection is having pain in the area of injection for a few days. The other complications are infection, bleeding and nerve injury.

Who should not have a medial branch block injection?

If you are taking blood thinners (Coumadin, Plavix, Ticlid or others) or antibiotics, have an active infection, or have a bleeding disorder you should not have the procedure without further discussion. Please warn us of any allergies you have, especially to local anesthetics, X-ray dye and latex.

Radiofrequency Ablation (also known as Radiofrequency Neurotomy) uses a specialized needle that carries heat generated via radiofrequency energy to lesion and destroy the functionality of the specific nerves carrying the pain signals which you are experiencing. This will effectively “silence” the nerves and reduce or eliminate your pain. Prior to inserting this needle, we will numb the local insertion site using anesthetics in order to minimize pain. We typically then target anywhere from 2 to 6 nerves for the procedure.

Nerve Ablation Surgery

We typically perform 2 types of radiofrequency ablation:

1. A medial branch neurotomy/ablation will “silence” nerves carrying pain signals from facet joints.
2. A lateral branch neurotomy/ablation will “silence” nerves carrying pain signals from sacroiliac joints.

Prior to a radiofrequency neurotomy, we will have performed a selective nerve root block (either medial or lateral branch) to verify that your pain is indeed coming from the specific joint region that we suspect. This diagnostic block would happen during a previous visit.

The success rate of an RFA procedure is generally about 70% for pain relief, and helps people who have neck pain, lower back pain, and spinal pain. Each patient is unique though, and so the success rate can have a wider range of between 60% and 85% based on the location and which joints are being addressed with the treatment.

RFA is called a minimally invasive non-surgical procedure because it does not involve removing any tissue or cutting the body. However, you’ll still want to avoid eating atleast 6 hours before your appointment, but you can drink clear liquids until up to 2 hours before the appointment. You should bring someone with you to drive you home after the treatment is finished, since you shouldn’t drive or operate machinery for 24 hours after the RFA is performed.

You can expect some soreness or pain near the injection sites for a few days. Strenuous activities should be avoided for a couple days at least, but most people can resume normal work activities in two to three days. As said earlier, it may take up to 3 weeks for the ablated nerve to stop causing pain completely, and if the pain is too much then analgesics can be prescribed in the mean time.

Right after the surgery you may experience burning or hypersensitivity at the injection site as a side effect. Numbness or tingling may also be experienced at the injection site. It can feel like sunburn, and can last for a few days or weeks, but can be treated with rest and some ice packs over the effected area. These symptoms are less common in the lower and mid back, but are more common in the higher levels of the neck.

RFA is a minimally invasive non-surgical operation, so it has the advantage of having less risk while being safe and effective at treating pain. It’s a well-tolerated procedure without many complications, though there is a small risk of infection, which is mitigated through proper surgical sterilization and asepsis protocols. Your doctor will discuss any complications or risks of radiofrequency ablation for your specific circumstances when considering the procedure as a solution.

Nerves can regenerate after the RFA procedure and start causing pain again. If this happens, the radiofrequency ablation can be repeated, and if the repeated operation comes up with the same results, a surgical intervention might be considered by your doctor. Up to 50% of patients usually see significant pain reduction for at least a two year period, but others may only get that pain relief in a short period. Some patients may not have any pain relief from a radiofrequency ablation at all, in which case surgery or other treatment options should be looked at.

Since RFA is using radiofrequency to stop signals from coming from your nerves you may experience slightly increased pain for a few days after the surgery, since the nerves are irritated. That is one of the normal side effects in a few patients and decreases after that first few days.If the pain doesn’t subside after the 3 week mark, you can attempt to repeat the procedure, as some people do. Or if the RFA relieves some of the pain, but there is still pain present you can couple it with other pain management techniques.

Because RFA is an outpatient procedure you can return home the same day it happens. You’re going to want to keep the area dry, but you can take a shower the following day and remove the bandages at that time. You can resume all normal activity in as little as 3 days, but you may not feel the full pain relief until after 2 weeks. Physical therapy is a great pursuit to help increase strength and gradual physical activity tolerance.