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Radiofrequency Ablation

Understanding Radiofrequency Ablation for Facet Joint Pain

Facet joints are small joints located in pairs on the back of the spine that run from the top of the neck to the bottom of the low back. Medial branch nerves are the tiny nerve branches that innervate these joints and communicate pain caused by these joints to the brain.

 

If you have had a temporary or “diagnostic” response to an initial and a confirmatory medial branch block, your physician may recommend a radiofrequency ablation for treatment. This procedure involves delivering a precise heat lesion or “burn” to the medial branch nerve so that it does not effectively transmit pain from the facet joint, which results in decreased pain and increased function.

What is Radiofrequency Ablation?

 

Radiofrequency ablation is a minimally invasive medical procedure that uses heat to destroy targeted tissue. In pain management, radiofrequency ablation targets specific nerves called medial branches that innervate the facet joints. The heat generated disrupts the nerve’s function, preventing it from transmitting pain signals to the brain. This can provide long-term pain relief for chronic pain conditions, especially arthritis in the back and neck joints, when other methods haven’t been successful.

The Benefits of Radiofrequency Ablation

 

Radiofrequency ablation targets the nerves that transmit pain signals from the facet joints in your spine to your brain. The goal is to disrupt the function of these specific medial branch nerves that supply sensation to the facet joints.

 

Radiofrequency ablation offers several benefits, particularly for those experiencing chronic back or neck pain:

 

  • Long-Term Pain Relief: While the pain relief from radiofrequency ablation is not permanent, it can offer significant pain relief for extended periods compared to steroid injections. Studies estimate the pain relief to last from nearly one to two years. In some patients the relief can last much longer.
  • Minimally Invasive: Because radiofrequency ablation is performed with a needle under fluoroscopic (x-ray) guidance, this procedure results in less scarring and quicker recovery than surgery.
  • Outpatient Procedure: We perform radiofrequency ablation on an outpatient basis in an in-office procedure room.

The Radiofrequency Ablation Procedure

 

  • An IV may be started so that relaxation and pain medication can be given.
  • You will lie face down on a procedure table.
  • The physician will use fluoroscopic (X-ray) guidance to visualize the spine.
  • The physician will scrub your skin with sterile soap, place a drape on your back, and numb an area of skin with anesthetic medication.
  • After the anesthetic has been given time to be effective, the physician will then direct a special needle using fluoroscopic guidance towards the medial branch nerve.
  • After the needle is in its proper location, your physician will inject a small amount of anesthetic medication and then “burn” the medial branch nerve for ninety seconds via a probe inserted into the needle..
  • This procedure may be repeated at one or more levels, depending on the location of your typical pain.

Pre-Op and Post-Op Instructions

 

Before the Procedure

  • You will be scheduled at one of our convenient locations, listed below, where you will be for approximately 1 hour total.
  • You will be required to have a responsible adult drive you home.
  • You should take your routine medications (i.e., blood pressure and diabetic medications) on the day of your procedure.
  • If you are taking a blood thinner and are having a cervical procedure, please notify the office immediately.
  • You must not eat any food six hours before your appointment.
  • You may have sips of clear liquids up to two hours before your appointment.
  • Wear loose, comfortable clothing to your appointment.

 

After the Procedure

Immediately after the procedure, you will go to a recovery area where you will be monitored for approximately 15-30 minutes. Of note, depending on the area treated, the arm(s) or legs(s) may feel weak or numb for up to a few hours after the procedure. You will not be allowed to drive on the day of the procedure if you have had sedation.

Plan to relatively rest for the remainder of the day after the injection. Avoid strenuous activities and heavy lifting. Light walking and gentle stretching are encouraged to promote circulation and healing. If you have had sedation, you may return to your normal activities the day after your procedure, including returning to work. 

Radiofrequency Ablation FAQs

Radiofrequency ablations are done to decrease pain associated with the facet joints in the spine. This pain is usually due to arthritis but can also be due to injuries such as whiplash.

Pain relief can vary from patient to patient. If successful, this procedure typically lasts between nine and eighteen months. Six months is approximately the minimum time needed for the nerves to re-grow. In some patients, the pain relief can last much longer or even be permanent. If the pain recurs, the radiofrequency ablation can be repeated (no earlier than six months). When radiofrequency ablation is repeated, it is not necessary to repeat medial branch blocks.

Everyone will feel a “pinch and burn” when the local numbing medicine is injected. Beyond that, feeling pressure as the needle travels to the target is normal. There can be mild discomfort while the needle travels to its target. Before the ablation or “burn,” additional numbing medicine is placed so this part of the procedure is as comfortable as possible. 

Some patients get conscious sedation for this procedure, which is a small amount of relaxing medicine called Versed. Sometimes, patients will require an additional small amount of pain medicine called Fentanyl.

Risks include but are not limited to bleeding, infection, nerve damage, paralysis, reaction to the medications used, and a temporary numb patch in the area of the radiofrequency ablation. These serious reactions are exceptionally rare.

Radiofrequency ablations are highly specialized procedures that require a fluoroscopy (X-ray) machine, physician(s) trained to do these procedures, an X-ray technician, and a nurse. In many cases, they require insurance authorization as well. Before a radiofrequency ablation, you cannot eat anything for six hours or drink anything for two hours. Finally, as stated above, two prior medial branch blocks must be successfully completed. Because of these reasons, radiofrequency ablations are scheduled on certain days of the week. Prior to any procedure, a clinic visit is typically done to review imaging, discuss the procedure in depth, review risks and benefits, and give the patient a chance to ask any questions. This helps the procedure run smoothly.

Because of the position you will be in (prone or on the stomach), there is a small risk of aspiration. This occurs when the stomach contents go up the esophagus and back down the windpipe. This risk is higher if sedation is given before the procedure.

Blood thinners are held prior to any cervical radiofrequency ablation. The reason this is done is that if there is significant bleeding near the spinal cord, this can cause paralysis. Therefore, clearance from the patient’s cardiologist must be obtained to hold the blood thinners for a certain number of days (depending on which blood thinner it is) before the procedure.

Radiofrequency ablations use lidocaine, which can temporarily cause the leg or arm to feel numb. This, coupled with IV sedation (when used), makes it dangerous to drive after the procedure. We recommend asking a friend or family member to drive you. We do not allow taxis or Uber/Lyft because the driver will not be able to help you get into your home if needed. If you arrive without a driver, you may be asked to reschedule.

You will be in our office for about 1- 1.5 hours. This includes checking in, reviewing risks and signing a consent form, placing an IV (if using sedation), performing the procedure, and recovering.

It is important to take it easy on the day of the radiofrequency ablation. If sedation is given, many patients go home and take a nap. Driving should be avoided until the next day if there is numbness in the limb or if sedation was used. Avoid soaking or submerging the injection area for 48 hours – this includes baths, hot tubs, or pools. Regular showers are OK. The band-aid placed at the injection site may be removed the same day as the procedure.

Pain improvement after the procedure is variable. 10-20% of patients will experience increased pain, which usually resolves within two weeks. It can take up to six weeks to achieve pain relief, which is the time needed for the nerve to fully degenerate after the ablation. Ice and over-the-counter pain relievers may be used for any increased pain after the procedure.

Call our office immediately if you experience a severe headache, severe pain in the arm or leg, redness or drainage at the site of the injection, fevers, chills, or weakness that is worse from the time after you leave the clinic. These symptoms are very rare. If you feel you require immediate medical care, call 911.

Radiofrequency ablations involve a thorough check-in procedure, which includes verifying the exact procedure, reviewing the risks and benefits of the injection, and placing an IV if sedation is used. Therefore, to help ensure our procedures run as smoothly as possible, we ask patients to arrive 30 minutes prior to their scheduled radiofrequency ablation. If you arrive late, you may be asked to reschedule. Please let us know at least 24 hours in advance if you need to reschedule or cancel your procedure. A “no-show” may result in a $100 fee.

Downloadable PDFs

Cervical Radiofrequency Ablation FAQs – PDF

Understanding Radiofrequency Ablation for Facet Joint Pain – PDF

Lumbar and Thoracic Radiofrequency Ablation FAQs – PDF