Radiofrequency Rhizotomy or RadioFrequency Ablation (RFA)

What is the purpose of it?
Radiofrequency rhizotomy or ablation is performed to provide long-lasting numbness to painful joints of the spine (facet joints and sacroiliac joints).

How long does the procedure take?
The procedure takes approximately 30-60 minutes to perform.

What is actually done?
The painful joints have been previously identified (see medial branch/facet joint injection section), and have been found to be respond to local anesthetic injection. Special probes, which can transmit radiofrequency waves to tissue are placed under fluoroscopic guidance next to the involved nerves. Testing is carried out with electrical stimulation to assure that the probes are appropriately placed. Local anesthetic is injected to numb the area. A thermal lesion is created which captures the nerve within the lesion, causing it to cease transmitting painful impulses, and leaving the joint numb.

Will the procedure hurt?
The procedure involves inserting the probe through skin and deeper tissues. So, there is some discomfort involved. We are able to numb the skin with a local anesthetic using a very thin needle prior to inserting the probe. However, we cannot anesthetize the deeper tissues until we are ready to create the lesion, because this would not allow us to electrically test for proper probe position. Therefore, this procedure does carry a moderate amount of discomfort until the testing is complete. Most of the patients also receive mild doses of intravenous sedative and analgesic medications, which makes the procedure easier to tolerate.

Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia and requires verbal feedback from the patient. Most of the patients also receive small doses of intravenous sedatives and analgesics, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance.

How is the injection performed?
It is generally done with the patient lying on the stomach or on the side and is performed under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. Afterwards, you are placed on your back or side.

What should I expect after the injection?
Immediately after the procedure, you may feel that your pain may be gone or reduced. This is due to the local anesthetic injected. This will last only for a few hours. The nerves that have been lesioned should be numb, but the lesioning procedure itself usually leaves an area of soreness which may last for up to two weeks. There may also be bruising of the area, which may last for up to two weeks.

What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You should apply ice to the affected area for the first evening. Perform activities as tolerated.

Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back or neck.

How long does the effect last?
The effect varies, but is expected to last for 1-2 years.

How many ablations do I need to have?
Sometimes the number of ablations is divided up among more than one visit, due to the time or discomfort involved in the procedure. When the effect begins to wear off, you may be advised to repeat the procedure, usually between 1 and 2 years.

Is there a limit to the number of ablations?
Since no medication is involved, there is not a specific limitation on number of ablations. As long as the procedure works well, and lasts for its expected duration, it can be repeated as necessary.

Will the Radiofrequency ablation help me?
If you have undergone prior medial branch or lateral branch nerve blocks with good relief of pain for the expected duration of the local anesthetic, it is likely that the radiofrequency ablation will be effective for you.

What are the risks and side effects?
The most common reaction after this procedure is soreness at the site, which may last for up to two weeks. There is a risk of damage to nerves not intended to be lesioned, which can result in new pain, unplanned numbness, or weakness. These effects are usually temporary, as the lesioning does not create “permanent” loss of function. However, the loss of function can be long-lasting, which is the purpose of the procedure. Other risks involve infection, bleeding, and worsening of symptoms. Fortunately, the serious side effects and complications are uncommon.

Who should not have this procedure?
If you did not undergo previous medial or lateral branch nerve blockade, you should not undergo radiofrequency lesioning, because it is not known if you will respond to this procedure. Certain insurance companies do not pay for this procedure, so you should check to make sure that you have coverage.