Radio Frequency Ablation (RFA)
Radiofrequency nerve ablation is the term used when radio (thermal) waves are generated to ablate (burn) the nerve. The
heat essentially destroys the nerve eliminating its ability to transmit pain signals.
Radiofrequency ablation is used to destroy the median nerves that supply the facet joints in the spine. There are two for each facet joint or “level.” These joints are the small posterior joints on either side of the spine. These joints can be one source of back pain.
How do we determine if a patient is a candidate for this procedure?
Pain management using radio frequency involves a several step process that may be different depending on the physician. The first part of the process requires that a patient has had an injection (medial branch block) with a local anesthetic at least twice to confirm the efficacy. Often times if a patient has had a facet injection the performing physician may only require one successful medial branch block. If positive relief of pain is achieved then the RF ablation for long term relief can be performed.
What is the procedure like for the ablation?
The patient will lie on their stomach in a prone position. Local anesthetic will be used to numb the entire treatment area. The patient should experience minimal discomfort throughout the procedure. The patient is awake and aware during the procedure to provide feedback to the physician on peripheral pain.
The technique used for the nerve ablation is similar to that used for the diagnostic blocks. A thin needle is inserted down to the region of the facet joint, which is responsible for the pain. Each joint has two nerves, which supply the joint therefore, 2 needle positions for each joint will be needed, depending on the number of levels affected. As during the blocks, the placement of the needle will be under fluoroscopic guidance. Once the needle is in place you will receive a numbing medication and the radiofrequency stimulation will occur through the needle already in place. This takes approximately 90 seconds for each site. This will be repeated at each additional site.
What recovery is required?
The patient is placed in a recovery room with continuous monitoring for a short period of time. The patients back may remain painful for up to 10-14 days after the procedure and is generally due to residual effects of the ablated nerve. After this period the patient will begin to feel pain relief.
What is the long-term effect of the procedure?
Once the nerves which carry pain sensation from the painful joint are destroyed you should be free of the back pain normally experienced. Pain relief may last over a period of approximately 9 months to 2 years or more. Time, physical therapy and increased muscle strength around this joint may make this joint less painful over the following 6 months so that if or when the nerves do regenerate you will not experience the same intensity of pain as prior to the procedure. If you have a recurrence of pain after 6 months, this procedure can be repeated at this time.
What are the possible side effects?
This procedure is a relatively safe, non-surgical treatment, with minimal risks of complications. Some of the most common or possible side effects are as follows:
- Allergic reaction to medications used during procedure
- Lack of pain relief
Thus it is important to be certain that your treating physician has a current list of allergies and medications to help reduce the risks during the procedure. Any and all side effects from the procedure should present within the first 24 hours following the procedure.
What should be expected for post procedure care?
Patients should have a follow up scheduled with their referring or treating physician 2-4 weeks post procedure to document efficacy and attend to any concerns patients may have about future treatment and expectations.
It is important tat you start a program of conditioning, strengthening, and range of motion exercises after an ablation. Ideally, increased muscle strength around the arthritic joints will make them less painful and give a greater chance of success. This will also lower the risk that you may experience the same amount of pain if the nerves regenerate. You may be asked to participate in a formal physical therapy program and your compliance will be necessary to facilitate the best possible outcome.