Radiofrequency ablation (RFA), also known as radiofrequency neurotomy or rhizotomy, is a cutting-edge, minimally invasive spinal injection procedure used to treat chronic pain localized in a specific area, particularly in the lower back and neck.
As the body ages, the joints can become arthritic. The bony structures connecting the vertebrae of the spine, called the facet joints, are no exception. With age, the facet joints can lose their pliability and elasticity, begin to rub against each other, generating irritation and inflammation and causing significant pain and discomfort.
The sacroiliac joint can also experience the effects of degeneration over time. It connects the lower spine to the sacrum and when inflamed can lead to low back pain and a lack of mobility.
RFA was first employed in 1931 to treat a painful facial nerve condition. As the technology developed, the use of RFA spread to deal with a variety of chronically painful circumstances, and the procedure has garnered increased popularity among patients and physicians, particularly over the last fifteen years.
How Does Radiofrequency Ablation Work?
RFA technology uses radio waves to create an electrical current. The goal of the treatment is to ‘burn’ off the affected nerves from the facet joints, thereby eliminating the pain signals sent to the brain from that particular area.
Before the procedure, the patient will be mildly sedated, and a board-certified anesthesiologist and pain management specialist will administer a local anesthetic. The injection will be conducted under live x-ray (fluoroscopy) to optimize needle placement and avoid unnecessary nerve damage.
First off, the physician will place a specialized radiofrequency needle next to the medial or lateral branch nerves in the spine. A small charge of electric current is sent through the needle to ensure that it is targeting only the affected nerves. Radiofrequency waves will then be carefully transmitted to heat the end of the needle and burn off the nerve, creating a lesion and inhibiting its capacity to relay pain signals to the brain.
The Benefits of Radiofrequency Ablation
Radiofrequency Ablation has been shown to provide relief of chronic lower back and neck pain related to arthritis, degenerative conditions, and injury.
Other benefits of RFA include:
- Minimal complications
- Increased range of motion
- Decreased dependence on pain relief medication
- Enhanced quality of life
- Quick recovery time
Additional advantages of the procedure that strengthen its allure for physicians and patients include the ability to have it done in an outpatient facility, the accuracy of needle insertion, and the option to repeat the treatment if necessary.
Is Radiofrequency Ablation Safe?
RFA is relatively safe and well-tolerated, with minimal complications during the procedure. Some potential side effects may include:
- Slight blood loss
- Skin discoloration
- Bruising at the needle site
Most side effects diminish after a few days. Some patients may experience lingering numbness for a few hours after the procedure.
As with most medical procedures, RFA contains certain risk factors and may not be indicated for patients who:
- Have an active infection
- Have blood clotting problems or certain heart conditions
- May be pregnant
Diabetic patients will need to adjust their insulin dose on the day of the procedure. As a rule, your physician will be able to advise you about your level of risk and if you are a viable candidate for RFA.
How Successful is Radiofrequency Ablation?
Success rates vary according to the study and patient selection. However, typically about 30% to 50% of patients who undergo RFA to treat lower back pain will experience considerable pain relief for up to two years, while roughly 60% of patients can expect effective pain relief for between six to eighteen months. Some studies have shown that as many as 60% of low back pain patients experienced 90% pain relief after one year. On average, most patients experience approximately six months of relief.
It is possible that nerves that have been destroyed during the process may grow back after six to eighteen months. However, nerve regeneration may not necessarily signal a renewal of the same intensity of pain experienced before the RFA procedure.
Physical therapy and regular exercise can help patients keep their lower back pain levels at bay.
Following completion of the procedure, doctors will closely monitor their patients for any adverse reactions including motor difficulties, mobility problems, paralysis, muscle weakness, and severe pain.
Immediately following RFA, patients are restricted from:
- Driving or operating machinery for at least 24 hours
- Engaging in strenuous activity for the first 24 hours
- Taking a bath for 1-2 days; showers are permitted
It can take up to four weeks for the charred nerves to completely lose their functionality, therefore, patients may experience some residual pain after the procedure. Physicians may recommend analgesic medication to help patients alleviate their pain during recovery.