- Radiofrequency ablation (RFA) uses heat to quiet the small nerves that carry pain signals from arthritic joints in the spine.
- It works for pain coming from the facet joints. It does not treat sciatica or pain from a pinched nerve.
- Test injections called medial branch blocks come first, to confirm those nerves are the source of the pain.
- Relief commonly lasts about 6 to 12 months and sometimes longer. The nerves grow back, and the procedure can be repeated.
What radiofrequency ablation is
Each level of your spine has a pair of small joints, called facet joints, that guide movement. Like knees and hips, they can develop arthritis. Tiny nerves called medial branches carry pain signals from those joints to the brain. They do not control any muscles in your arms or legs.
In radiofrequency ablation, a thin needle is placed next to the medial branch nerve under X-ray guidance. A radiofrequency current heats the tip of the needle and creates a small, precise lesion on the nerve so it can no longer send the pain signal. The joint is still arthritic, but you feel far less of it.
Who it helps
- Neck or back pain that is mostly in the spine itself, and not shooting down an arm or leg
- Pain that is worse with standing, arching backward or twisting
- Pain that has lasted more than a few months despite physical therapy, activity changes and medication
- Pain that improved clearly, but temporarily, after diagnostic medial branch blocks
RFA is not the right treatment for sciatica, a herniated disc pressing on a nerve, or spinal stenosis. Those problems are treated differently, often with epidural steroid injections.
The test comes first: medial branch blocks
Imaging alone cannot prove that a facet joint is causing pain. Many people have arthritis on an MRI and no pain at all. So before RFA, a small amount of numbing medicine is injected onto the medial branch nerves. If your usual pain drops substantially for the few hours the numbing medicine lasts, those nerves are very likely the source. Most insurers, and published guidelines, call for this test before ablation, and it is often done twice.
What the procedure is like
- You lie on your stomach on an X-ray table. The skin is cleaned and numbed with local anesthetic.
- Using live X-ray, the physician guides a thin needle to each target nerve.
- A brief test confirms the needle is in the right place and safely away from the nerves that control your muscles.
- The nerve is numbed, then heated for about a minute or two at each site.
- You go home the same day. Because only local anesthesia is used, you do not need a driver.
The ablation itself takes about 5 to 10 minutes. It is done under local anesthesia, without IV sedation. If you would like an oral sedative, ask 2 to 5 days before your procedure and it will be called in to your pharmacy. If you take it, you must have a driver bring you and take you home.
Where it is done
All injections and procedures are performed in the surgery center on the 2nd floor of the Orlando Health Jewett Orthopedic Institute Downtown Complex, 60 Columbia Street, Orlando. Dr. Braithwaite’s clinic is on the 4th floor of the same building (Suite 400), and he also sees patients in Winter Park. Procedures are done under local anesthesia, without IV sedation.
Saturday and evening appointments. Because the practice is busy and many patients travel a long way to be seen, Dr. Braithwaite routinely offers Saturday clinic and Saturday procedures, along with some evening hours. If that would help you, please ask when you call.
Recovery and when relief starts
Soreness at the needle sites is normal for several days and can last a week or two. Some people notice a patch of skin that feels sunburned or numb for a few weeks. Ice and over-the-counter pain medicine usually handle it. Most people return to desk work and light activity within a day or two.
Relief is not always immediate. It commonly builds over two to three weeks as the treated nerves stop conducting. This is a good time to restart physical therapy and strengthen the muscles that support the spine.
How long it lasts
Relief commonly lasts about 6 to 12 months, and for some people a year or more. The nerves slowly grow back. If the pain returns, the procedure can be repeated, and repeat treatments often work as well as the first.
Risks
- Temporary soreness, bruising or muscle spasm at the treatment site
- A temporary increase in nerve pain or a burning, sensitive patch of skin
- Infection or bleeding, both uncommon
- Injury to a nearby nerve, which is rare when the procedure is done with X-ray guidance and testing
Tell your physician beforehand if you take blood thinners, have a pacemaker, defibrillator or spinal cord stimulator, have an active infection, or could be pregnant.
Sources
This page is general education and is not medical advice. It does not replace an evaluation by your own physician, who knows your history and can examine you. If you have new weakness, numbness in the groin, loss of bladder or bowel control, or other emergency symptoms, call 911 or go to the nearest emergency room.