Radiofrequency Ablation
Radiofrequency ablation (RFA) is a minimally-invasive outpatient procedure that provides long-term pain relief by interrupting the nerve supply to painful joints in the neck and back. The joints of the spine, also known as the facet joints, transmit pain signals to the brain by the medial branch nerves. After undergoing a set of diagnostic nerve blocks called medial branch blocks (MBBs), the physician can determine if the patient’s pain is truly originating from the facet joints and target the therapy to these specific joint levels. RFA is a procedure that utilizes a specialized device to direct heat through an insulated needle with a probe, causing the tip of the needle to deliver controlled heat along the painful nerve. This disrupts the pain signals and provides long-term pain relief. The procedure can be performed at any level of the cervical, thoracic and lumbar spine, as well as the knees and other pain syndromes.
The procedure is typically performed on one side at a time, and at multiple joint levels. After the skin is anesthetized and the needles are correctly positioned under fluoroscopic (x-ray) guidance, an electrode is placed through the needles causing sensory and/or motor stimulation. This non-painful stimulation confirms that the needles are correctly positioned over the painful nerve of interest. The nerves are then carefully anesthetized for several minutes. Once the nerves are properly numbed, the tip of the needle is then heated by the probe through radiofrequency up to 60-85 ⁰C for 1-2 minutes, resulting in denervation of the nerve. Afterwards, additional anesthetic solution and a small amount of steroid is deposited before the needle is removed.
Radiofrequency ablation will result in the same pain relief experienced with the medial branch block, but the pain relief will last for at least 6-9 months, with many patients experiencing pain relief for 12-18 months or more. The medial branch nerves will regrow, and should the patient’s pain return at that time, the procedure can be repeated after 6 months or more. Potential complications of the procedure are rare, but include bleeding, infection, temporary worsening of pain symptoms and sensitivity at the injection sites. Multiple, large evidence-based studies have shown radiofrequency ablations to be among the most successful procedures in the diagnosis and treatment of chronic joint pain.
