Frequently Asked Questions on Radiofrequency Ablation
Radiofrequency ablation is the most modern treatment available for treating facet joint related pain in the neck, mid back, and low back area. It is also becoming more common in the sacral area as well.
What exactly is a Radiofrequency Ablation?
The procedure goes by a few different names. Most commonly it is called radiofrequency ablation, but it also is termed radiofrequency neurotomy, radiofrequency rhizotomy, radiofrequency lesioning, medial branch neurotomy, or radiofrequency denervation.. The procedure involves electromagnetic waves traveling at the speed of light. It is a form of heat energy created by a special generator operating at extremely high frequencies.
The resulting heat energy is delivered precisely to the area of nerve endings that are causing the person’s pain. This can provide pain relief for a few months upwards of a couple years. Because of this extensive time frame, radiofrequency ablation (RFA) is considered one of the most modern innovations in pain management today.
Why is a Radiofrequency Ablation procedure performed?
The ablation procedure is utilized to give individuals longer pain relief than what is typically achieved with an injection of cortisone or simply numbing medication. The procedure works well for facet arthritis, also called facet syndrome. The facet joints are small thumbnail size joints situated on either side of the spine all the way up and down from the neck down to the sacrum.
Facet joints are prone to arthritis just like any other joints that have cartilage. Each facet joint contributes to incredible ranges of motion in the spine. As an individual ages or experiences a trauma such as a car accident or whiplash, the joints have injury to them which can create pain for patients. Cartilage is lost or damaged, and it is amazing how such a small joint can create such intense pain.
Most patients who undergo a radiofrequency ablation have had injections of numbing medicine and possibly steroid medicine in or around the facet joints, epidural steroid injections, or other nerve blocks that achieved relief but then wore off.
The most common procedure performed by far in pain management today is a facet injection. The injection usually works very well, and may include an injection into the joint itself or around it which is a procedure called a medial branch block. Often times radiofrequency alation iis a follow-up to one of these procedures that worked well and wore off. By applying the significant heat energy, the small nerve endings may be deadened for a much longer time, potentially for one to two years.
How does a radiofrequency ablation procedure provide pain relief?
The theory behind a radiofrequency ablation procedure is that as one generates heat around the nerve endings, their ability to transmit pain signals to the brain is eliminated. This theory has been put to the test and it has been shown that the RFA procedure is one of the most successful in pain management today.
How is a radiofrequency ablation procedure performed?
As mentioned, the radiofrequency ablation procedure is typically a follow-up to a facet block or a medial branch block that worked well and then wore off. An RFA procedure is performed as an outpatient either in a pain doctor’s procedure room or at a surgery center. The procedure may be performed with IV sedation but it is not absolutely necessary. Individuals who have an anxiety issue or have had a good sedation experience with procedures before may desire this addition.
The patient is situated on a table that allows x-ray beams to go through it with a real-time form of x-rays called fluoroscopy. This is to ensure the most accurate needle positioning possible. The first step is numbing up of the skin and the track down to the affected area near the neck, mid-back or low back being treated. Usually if an individual has facet arthritis pain, it involves more than one level so the pain doctor will be treating multiple at one time. The pain management specialist may treat them all simultaneously or may simply do one side at multiple levels and then bring the patient back a week later for the other side.
The next step is for the pain doctor to place the catheters over the area of the facet joints being treated. This is done as mentioned with fluoroscopy and once the positioning is satisfactory, contrast dye is injected to make sure the needle is not in a blood vessel.
At this point the needles are stimulated by the radiofrequency machine to make sure that they are not too close to an actual nerve root which could make the patient’s leg jump. These tiny little nerve endings that are being heated are only sensory in nature and have no motor function. Since these tiny nerve endings don’t provide any motor function, the pain doctor does not want to see any leg jerking.
Assuming the positioning is deemed to be appropriate, the next step is to apply heat energy through the catheter to the affected area. This is called medial branch thermal coagulation and the amount of heat applied and the duration it’s applied depends on which part of the spine is being treated.
The average heat is around 80°C and the average timeframe is 90 seconds. Once the procedure is completed, catheters are all removed and bandages are applied. Typically the patient will be watched for 30 to 60 minutes to ensure stable vital signs. The procedure itself usually takes between 20 to 45 minutes.
How well does a radiofrequency ablation procedure work?
Pain relief with a radiofrequency ablation has been studied extensively in the literature. The effectiveness varies in research studies between 50% upwards of 90% and the amount of time has been shown to be between 6 to 24 months. One study actually showed an average pain relief of approximately 470 days which is approximately 16 months.
Unfortunately the tiny little nerve endings may grow back and the pain may come back as well. This is not the end of the world, as the procedure may simply be repeated with the expectation that more good results will occur.
What are the risks associated with radiofrequency ablation?
Overall, the risk profile of an RFA procedure is very low, under one percent. One risk that is not well-known is that a patient may have increased pain due to muscle spasms from the procedure for 1 to 2 weeks afterwards. It does not mean the procedure didn’t work, it may simply mean that it hasn’t kicked in yet as the spasms need to subside.
Another potential risk is that the nerve endings may only be partially deadened and the pain may actually be worse as a result of that for a few months. Another complication Is numbness of the skin over the injection site which is usually well-tolerated. As with any interventional procedure, there is a small risk of infection and a very rare risk of spinal cord trauma. Another rare risk is that a motor nerve may be damaged which is why the motor check was done during the procedure to minimize that potential.
If you live in Arizona and are suffering from neck pain, mid back or low back pain, the pain doctors at Arizona Pain are experts in radiofrequency ablation procedures. The doctors are Board Certified and Fellowship Trained, and have treated thousands of patients with radiofrequency ablation procedures.
You will be in excellent hands at Arizona Pain Specialists which has AZ pain center locations throughout the valley serving Phoenix, Scottsdale, Glendale, Chandler, Tempe, Gilbert, Surprise, Goodyear, essentially all areas throughout Maricopa County and even Maricopa Arizona itself.