Radiofrequency (RF) Neurotomy of the facet joints is a treatment option for those patients who have had significant pain relief (generally greater than 80%) from injection of the facet joints or medial branch nerves, but the relief is temporary.
The goal is to deaden the small nerves that give feeling to the joint, using heat from a special needle. Two nerves need to be treated per joint. These nerves cannot be seen with X-ray, but their location along the bone is fairly predictable. Thus, to be sure the RF lesion is made in the correct location, test blocks (also know as medial branch blocks) will be done using different freezing solutions. If significant pain relief is experienced, the patient is considered a good candidate for the RF neurotomy
Before Your RFA
Please let us know if you are allergic to Betadine (iodine skin cleanser), Iodinated Contrast Material (CT Scan dye), or Lidocaine (freezing), have a pacemaker or an implanted neurostimulator or if you tend to get lightheaded or faint with procedures involving needles, so we can make sure you are safe during your time with us.
Bring a Driver and Plan to Stay a While
A radiofrequency ablation may impact your ability to operate a vehicle safely, so we require you to come with a driver. Though our goal is to get you in and out in 45-60 minutes, each patient we treat has unique needs, which can often require more time than anticipated. As such, we’d ask that you be prepared to stay for as long as 90 minutes (let your driver know).
You will be positioned on the procedure table so the physician has easy access to the area being treated. The area will be sanitized using an iodine or chlorhexidine solution to clean the area (please tell the physician if you are allergic to iodine solution).
In order to make you more comfortable, local anesthetic (freezing–similar to that used by your dentist) will be injected in and around the area being treated. Using fluoroscopy (real-time Xray) the physician will guide a special needle to the nerves carrying your pain signal. More local anesthetic will be injected to minimize discomfort and then a small section of the nerves will be ablated (burned) in order to interrupt the pain signal. During this time, you may experience a burning or muscle cramp sensation, which is completely normal. Once all the target nerves are treated, the needles are then removed, the treatment location is cleansed, and adhesive bandages are applied. You will be observed for approximately 20 to 30 minutes and then discharged to the care of your driver.
After Your RFA
The Next Few Days
Expect to feel some soreness where the needles were inserted but this pain will fade away over a few days. Apply ice packs for 15-20 minutes every couple of hours to address pain or swelling. Avoid swimming or bathing for 48 hours post-procedure (warm showers are okay). Most patients feel well enough to return to work the next day but your back may ache for two weeks or more after the procedure. Tylenol or oral anti-inflammatory medications are typically enough to address any discomfort you may feel during this time.
Relief usually begins approximately three weeks following treatment and usually lasts approximately one year. This RFA can be successfully repeated when the pain comes back. By engaging in physical rehabilitation you can improve your function and possibly the magnitude and duration of pain relief.
The Role of Rehab
An RFA does not address the root cause of your pain – it simply interrupts the pain signal. However, the temporary relief it provides opens a window of opportunity for you to strengthen the treatment area and protect against future injury. This is why we strongly recommend that, within a couple of weeks of your procedure, you see a Physiotherapist or exercise specialist. We can provide a referral letter for you.
Measuring your Improvement
Prior to your procedure, you will be asked to complete a questionnaire that helps us measure your current level of pain, disability and quality-of-life. Approximately three months later, we will ask you to complete the questionnaire again so we can compare the changes and determine if this treatment should be considered for you in the future. If the treatment has not provided the expected relief, we will be happy to reevaluate you to determine why and what more can be done.
Minor soreness at the injection site is most commonly reported. Pain flare-ups are uncommon and treatable with painkillers. Aseptic technique is observed so incidence of infection is extremely low. We screen for allergies to freezing so severe allergic reaction is uncommon. Complications from these types of procedures are rare, especially when delivered by a skilled practitioner using image guidance. However, neurological complications such as weakness and numbness are noted risks.
60 - 80% of patients experience good to excellent pain relief for at least 8 - 18 months. The procedure can be repeated.
A regular spine exercise program may improve the success of the procedure.
You will be contacted by the CAPRI clinic ~3 months after your treatment to determine if there has been improvement in your pain, disability and quality of life. If that is not the outcome, we may schedule a follow-up appointment to re-evaluate your condition.