Spinal Radiofrequency Ablation

Overview

Radiofrequency ablation (RFA) is a procedure that uses heat to destroy tissue. Individuals with chronic back and neck pain, as well as pain from conditions like arthritis, are ideal candidates for radiofrequency ablation.  RFA is typically considered for long-term pain conditions, especially in the neck, lower back, or arthritic joints, when other treatments have not been effective.

This procedure reduces pain by heating a small area of nerve tissue, interrupting pain signals to the brain. While it doesn’t eliminate pain, it can block these signals for a period ranging from 3 months to 14 months, varying by individual. Most patients experience significant pain relief after this procedure.

The procedure involves the usage of radiofrequency energy to create a heat lesion that prevents nerves from generating pain signals to the brain.

 Two distinct types of radiofrequency ablation can be performed:

1. Medial branch ablation involves performing a heat lesion on the nerves that transmit pain signals from the facet joints.
2. Lateral branch ablation involves performing a heat lesion on the nerves that transmit pain signals from the sacroiliac joints.

Both nerve branches do not impact any muscles or sensations felt in the arms and legs, thus diminishing any risk posed by the procedure. The procedure will be done following the completion of a medial or lateral branch nerve block, which is done to ascertain the root cause of the pain. It’s almost like a diagnostic procedure done in the run-up to the radiofrequency ablation.

Success rates for radiofrequency ablation vary by individual. Around 30-50% of patients experience relief from lower back pain for up to two years after the procedure. The remaining patients may experience relief for a shorter duration.

Procedure

Radiofrequency Ablation involves mild sedation and local anesthetics. The procedure uses fluoroscopy for guidance, similar to other types of injections. The patient receives IV sedation, and the targeted area (mid-back, lower back, or neck) is cleansed with alcohol and antiseptic solution. Under fluoroscopy guidance, a radiofrequency needle is inserted under the skin and guided to the nerve transmitting pain signals. The specific nerve(s) is numbed with anesthetic, and the lesion is created using radiofrequency waves to heat the nerve(s), blocking pain signals. The procedure may be repeated for multiple nerves emitting pain signals.

Radiofrequency Ablation typically lasts 30-90 minutes and does not require an overnight stay, allowing patients to go home after recovery. It is advised to avoid driving and strenuous activities. Soreness in the treated area may occur during the first 1-2 days, rarely along with muscle spasms and irritability from the dying nerves. This process can last a few days in some patients. 

Radiofrequency Ablation (RFA) might be suitable if you have:

Experienced pain relief from a nerve block injection, indicating that the nerve is the source of your pain and a suitable target for RFA.

Chronic pain that hasn’t responded to other treatments like medication or physical therapy.