Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA), also known as radiofrequency neurotomy or rhizotomy, is one of many pain reducing procedures. It is a non-surgical procedure in which radiofrequency waves are delivered to certain nerves to interrupt pain signals to the brain. Sensory nerves, not motor nerves, are targeted.

RFA is usually used to treat pain from the facet joints, which can contribute to pain in the neck or lower back, the sacroiliac joints, which can contribute to low back pain.

Pain from neck facet joints can radiate to the head, neck, shoulders, shoulder blades and arms. When headaches emanate from neck facet joints, the location is commonly in the occiput or back of the head.

Pain from low back facet joints can radiate to the low back, hips, buttocks and legs.

Pain from the sacroiliac joints can radiate to the low back, buttocks, hips, groin areas and legs.

Facet joints are pairs of joints at each vertebral level on both sides of the spine. Two medial branch nerves carry pain signals away from each facet joint to the spine and brain.

The sacroiliac joints are at the lowest part of the spine, between the sacrum and ilium on both sides of the pelvis. The dimples, above the buttocks, are near or at the level of the sacroiliac joints. The sacroiliac joints, like the facet joints, are supplied by nerves that carry pain signals to the spine and brain.

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Pre-Procedure

  • You cannot drive for at least 24 hours after the procedure. Therefore, someone must drive you home afterward.
  • It is vital to not eat or drink anything after midnight the night before the procedure, except for a little water to take medications if needed.
  • If you have insulin-dependent diabetes, it is vital that you adjust the dosage of insulin the day of the procedure since you should not eat or drink anything after midnight the night before. The doctor who manages your insulin or other diabetes medication should make any appropriate adjustments. Bring your diabetes medication with you so it is available for you to take after the procedure is completed.
  • Blood-thinning medications or antiplatelet medications must be stopped but only with the permission of your doctor who prescribes and manages these medications. Your pain management specialist will provide you with a list of these blood thinning and antiplatelet medications well before the procedure.
  • Do not stop, but rather take all other medications with a little water. Bring all medications with you so you can take them after the procedure is completed. You must not stopany medication without first discussing this with your primary or prescribing doctor.

Procedure

RFA is a procedure that does not require general or intravenous anesthesia. During the procedure, you will lie on your stomach. For neck procedures, you might lie on your side. An oral sedative, to relax you, is recommended and provided by your pain management specialist.

The skin, around the area of your spine to be treated, is numbed with a local anesthetic. Similarly, numbing of the skin is performed if the sacroiliac joint is being treated.

The doctor will then use X-ray guidance (fluoroscopy) to direct a radiofrequency needle alongside the targeted nerves. To confirm the proper position of the needle, a little electrical current is passed through a probe placed in the needle to the nerve being targeted. This may cause a brief pain and/or a muscle twitch which confirms that the doctor has identified a pain generator.

Once proper position is confirmed, more local anesthetic is injected into the area where the RFA will be performed. For most patients, the procedure is painless or produces a mild warm sensation.

The procedure may take 30 to 45 minutes depending on the location site and number of nerves treated.

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Post-Procedure

After the procedure, soreness or spasms may occur in the targeted area for a few days. Rare complications include nerve damage, bleeding, and infection.

Although results vary, RFA may provide effective pain relief for three to 12 months. Often the nerve will regenerate over time, and the joint pain may return. RFA can be repeated if the facet joint or sacroiliac joint pain returns.

Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).

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