The vertebrae of the spine are separated by discs, and connected at the back by facet joints that act as hinges. Just as a hinge can become rusty and less mobile, the facet joints in the spine may develop arthritis or other issues that can generate pain symptoms.
Degeneration of facet joints in the neck and low back can be responsible for a large percent of chronic neck and low back pain.
Epidural steroid injections (ESIs) are often tried first to address pain symptoms in the neck and low back. But when these injections don’t relieve symptoms — or if a patient is unable to receive a steroid injection — the next treatment option for pain relief can be radiofrequency ablation (RFA), which is also referred to a “rhizotomy”, Rhizotomy, or radiofrequency ablation, is a procedure in which the physician may use heat to intentionally damage the ability of a problematic nerve to telegraph pain signals to the brain. While pain signals serve to warn us about danger or injury, sometimes a nerve can end up in a "stuck" position, sending a continuous pain signal to the brain.
If radiofrequency ablation is determined to be the next treatment option, the patient is scheduled for two diagnostic nonsteroid lidocaine blocks to confirm the exact levels necessary for RFA. Most health insurance companies require these diagnostic blocks before an RFA can be performed to ensure the RFA procedure is targeting the corrent facet joint levels. The small injections typically provide immediate pain relief than can last several hours. The success of these injections determines if RFA would be successful in longer-term pain relief.
Radiofrequency ablation is performed in the office or an ambulatory surgery center under x-ray guidance with a C-arm. Typically there is a moderate IV sedation. During a RFA procedure electrical current produced by a radio wave heats up a small area of nerve tissue, effectively reducing the nerve’s ability to transmit pain signals from that specific area to the brain. The result is that the person no longer feels pain from that specific area.
The RFA “rhizotomy” procedure takes about 20 minutes. In some cases it might take slightly longer if there is significant arthritis or bone spurs that affect needle placement during the RFA procedure.
Patients are placed face down on a special x-ray table and the skin at the injection site is sterilely prepped. Numbing medication is then used to anesthetize the skin and tissue deep to the skin to make the procedure more comfortable. An x-ray machine called a C-arm fluoroscope is used to monitor placement of the probe. Patients are monitored for a short time before being discharged home.
Pain relief can last six months or longer, and in some cases, several years. It’s estimated that 70% of people who under radiofrequency ablation have pain relief. While arthritis can’t be cured, the area that is generating the pain signal is numbed through the RFA procedure.
Generally, there are few complications from the procedure. As with any invasive procedure, there is a slight risk of infection or minor bleeeding from the insertion site. There may also be slight bruising at the insertion site but this disappears in a day or so.