Leon E. Popovitz, MD
Top-Rated Orthopedic Surgeon
Specializing in Arthroscopic Surgery of the Shoulder & Knee.
For appointments 212.759.4553

Radiofrequency Ablation or Neurotomy

Radiofrequency ablation is a long-term therapeutic procedure to alleviate spinal pain by disrupting nerves carrying pain signals that are resulting from damaged facet joints. Compression or irritation of spinal nerve roots cause pain by sending pain signals to the brain. Though radiofrequency ablation does not correct any issues causing the nerve irritation, it does disrupt the pain for extended periods of time, allowing a patient to proceed with physical therapy and live comfortably.

Cervical Radiofrequency Ablation

Cervical Radiofrequency Ablation is a process that disrupts pain signals from the medial branch nerve in the neck. The cervical region of the spine is the neck, consisting of seven vertebrae, connected by facets joints. It is these joints that allow for rotation of the neck. Medial branch nerves are located near these facet joints, transmitting pain to them after injury or trauma. Cervical facet pain occurs upon injury that has damaged either the cartilage inside of them or the ligaments surrounding them. Depending upon where the damage is, facet joint injuries can cause pain from the back of the head, resulting in what feels like a migraine, down the neck and to the upper shoulder. Cervical Radiofrequency Ablation treats this chronic pain.

Thoracic Radiofrequency Ablation

Thoracic Radiofrequency Ablation intends to stop pain signals around the upper and middle back. This area of the spine is referred to as the thoracic region and contains twelve vertebrae, one atop the other, connected by facet joints. These facet joints are surrounded by ligaments that support movement and medial branch nerves that transmit pain signals to the brain. Upon injury to a facet joint cartilage or surrounding ligaments, pain will radiate from the upper to mid back area.

Lumbar Radiofrequency Ablation

Lumbar Radiofrequency Ablation is an outpatient procedure that disrupts the medial branch nerves of the lumbar region of the spine from sending pain signals to the brain. The lower back portion of the spine contains five vertebrae, all connected on either side by facet joints. Surrounding these joints are nerve roots and ligaments that support movement. When damage occurs to the cartilage within the joint or the ligaments connected to them, it can cause chronic pain in the lower back, hip, groin, and buttocks area. Lumbar Radiofrequency Ablation treats this chronic pain.

Causes of Facet Pain

Damage to the facet joints are most commonly fractures caused by trauma. Other cause of facet pain include:

  • Regular aging
  • Degenerative disc disease
  • Facet disease
  • Spinal stenosis
  • Bone spurs or tumor
  • Facet joint osteoarthritis

Diagnosis

If pain continues to radiate from the back to the extremities despite following a physical therapy routine, the facet joints may be the underlying problem. One of two tests will be given to a patient to determine if facet joint damage is the source of pain. Facet injections and medial branch blocks can both determine if a patient would benefit from radio frequency ablation. If a patient responds well to these short term pain relief injections, they may receive longer lasting pain relief from radio frequency Ablation.

Preparing for the Procedure

  • Arrange for a ride home from the procedure.
  • Plan to rest for the day.
  • Notify your physician about any medications you are taking.
  • Do not eat or drink for doctor recommended amount of time.

The Procedure

An IV is usually given beforehand to relax muscles. The physician then sanitize the lower back and insert a long, thin needle into the diagnosed facet joint or nerve branch. Local anesthetics will numb the area to this pain. The physician will test if it is in the precise location it should be by stimulating the needle. This may cause slight pain and a twitching response from the muscles. The needle will then transmit radio frequency waves into the body, heating, or ablating, the nerve branch. Ablating nerves disrupts their ability to send pain signals to the brain.
The patient will be monitored for up to thirty minutes after the Lumbar radio frequency ablation is complete to ensure there are no immediate reactions. It is then important to move the area in the following weeks and record any changes in pain and mobility. The patient may return to work the following day.

Results

Once the local anesthetics wear off, the injection site will feel sore for a few days. The patient may experience possible itching, numbness or weakness of the lower back, hip, buttocks, or groin areas for a few weeks following the radio frequency ablation procedure. Once the aching of the injected area wears off, the ablation should provide the patient with months to years of pain relief. The actual time period before another radio frequency ablation is needed will vary from between patients. The procedure may be repeated as necessary without any ill side effects.

Risks

For any deep tissue injection, infection and bleeding are a rare possibility. Nerve injury is a very infrequent risk associated with radio frequency ablation.

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