What is radiofrequency ablation?
Radiofrequency ablation is the use of radio waves to heat the fluid around certain structures. When it is used for spinal pain, it effectively destroys the tiny nerves transmitting pain signals to your brain from your facet joints (also called “zygaphopyseal joints,” see diagram below). Pain from facet joints is common, particularly as the general wear-and-tear on these joints over time causes degeneration and arthritis. Most people with facet joint pain have axial pain (along the spine), usually in the lower lumbar region. Your pain may be worse with lumbar extension, twisting backwards, and prolonged standing.
What nerves are targeted?
Radiofrequency ablation is used to target pain from the facet joints, which are the articulating joints between the vertebrae of your spine. The actual nerves being destroyed are called “medial branch nerves,” and each facet joint receives its innervation from the medial branch at (ascending branch) and one level above it (descending branch).
To View Anatomy in an Interactive Computer Module courtesy of the Bay Area Pain Associates, Please visit this site: http://www.bayareapainmedical.com/wnrotomy2.html
Are you a candidate?
All patients need to have a thorough evaluation and diagnostic work up by their doctor before they can be considered a candidate for radiofrequency ablation. Then, the treating physician will have you undergo diagnostic facet joint blocks first, to see if the pain is really coming from your facet joints. Several levels are usually injected at once, using a short-acting anesthetic (i.e., lidocaine or marcaine). These facet blocks must be done under X-ray guidance, and the procedure usually takes ~10-15 minutes. Soon after the injections, while you are still in the waiting room, you should feel relief from your low back pain. The blocks are only meant to last a short period of time, and your pain will return when the anesthetic wears off. If you respond well to these blocks, and have relief of your pain for the duration of the anesthetic that was injected, you may be a candidate for radiofrequency ablation therapy. It is often the protocol to have 2 sets of diagnostic blocks before undergoing radiofrequency ablation.
What to Expect
How long should you be pain free after radiofrequency ablation?
Successfully treated patients report 6-9 months relief or longer. After this time period, the medial branch nerves slowly grow back. This may or may not be a bad thing – some report relief for years without having to undergo the procedure again. There is always a small percentage of people who don’t respond to the procedure and still have back pain from their facets or other pain generators in the spine. Remember, chronic back pain can be complex, involving numerous structures and pathways. The facet joints are a good target for intervention, however, if you are truly experiencing facet-related arthritis and pain.