A treatment for back or neck pain coming from the facet joints, the small paired joints at the back of each spinal level. Each joint is supplied by tiny nerves that carry pain from it, and those nerves can be switched off with heat delivered through a needle. There is no incision or implant, and nothing is removed.
Radiofrequency Neurotomy of the Lumbar Facets. Licensed patient-education animation, ViewMedica.
Each level of the spine is joined to the next in three places: the disc at the front, and a pair of small facet joints at the back. Those joints carry load, guide how the spine bends and wear out like any other joint, which can be painful.
Each facet joint is supplied by medial branch nerves, which do very little else. They do not control any muscle you would miss, and they do not carry feeling from your skin or your leg. If the joint is the source of the pain, switching these nerves off stops the pain with very little other effect.
Radiofrequency ablation does that with heat. A fine insulated needle is placed alongside the nerve under X-ray guidance, and a current at its tip warms the surrounding tissue enough to stop the nerve conducting.
Medial branch anatomy and probe placement. Posterior oblique view of a lumbar level showing the facet joint, the medial branch nerve crossing the junction of the transverse and superior articular processes, and the radiofrequency cannula positioned parallel to the nerve.
Facet joints look worn on almost everyone’s scan past middle age, and most of that wear causes no pain. So imaging can only show which joints might be the source. Treating joints on the strength of a scan alone is a common reason this procedure fails.
A medial branch block can tell. The same nerves are numbed with local anesthetic, using the same X-ray guidance and the same targets. The block is used as a test:
Local anesthetic is placed on the medial branches supplying the suspected joints. It wears off within hours, as it is only meant to show whether the pain stops.
You are asked to note how much your usual pain changed and for how long, and to test it by doing something that normally hurts. This pain diary is the result of the test.
Substantial temporary relief means the numbed nerves were carrying the pain, so treating them for longer is likely to help. Little or no relief means they were not, and an ablation would not have worked either.
A second confirmatory block is common, and is required by many insurers before ablation is authorized. It guards against a placebo response on a single occasion.
A block that does not help is still a useful result, because it points the search somewhere else before an ineffective treatment is tried.
Facet joint pain has a fairly consistent pattern, close to the opposite of disc and nerve-root pain.
Pain often spreads into the buttock or the back of the thigh, or from the neck into the shoulder or the back of the head. Facet pain does not usually run below the knee or into the hand along the path of a single nerve, which points to a pinched nerve root instead.
The last one is the most important. Radiofrequency ablation treats a pain signal and does nothing about pressure on a nerve or on the spinal cord. Weakness, numbness or a compressed cord need the compression itself treated.
Tell the team about any implanted cardiac device before scheduling. Radiofrequency current and pacemakers or defibrillators interact, and this is managed with straightforward precautions when it is known about in advance.
You lie face down and the area is cleaned and numbed. The procedure is done under live X-ray guidance; sedation is available but you stay responsive enough to answer questions during testing.
Insulated needles are advanced to the bony landmark each medial branch crosses. They are laid as nearly parallel to the nerve as the anatomy allows, because the heat forms along the side of the tip and a needle placed across the nerve may miss it.
Stimulation through the needle confirms the position twice over: a sensory test reproduces your familiar pain, and a motor test checks that nothing supplying a limb is nearby. Placement is adjusted until both are right.
Local anesthetic is given through the needle, then the tip is heated for roughly a minute to two per site. Each targeted joint needs two nerves treated, because every facet joint is supplied from the level above as well as its own.
The needles come out, a dressing goes on, and you are observed briefly. Most people are driven home within the hour and back to ordinary activity the following day.
Medial branch radiofrequency ablation. Cannula placement along the medial branch under fluoroscopy, sensory and motor testing, and the lesion forming along the length of the active tip.
Ablation works differently from an injection in two ways.
Ablation does not change the joint itself, and the arthritis is still there afterwards. It only stops the joint sending pain signals, which is why the diagnostic block matters so much.
Dr. Zaidi performs three needle-based procedures for spinal pain, each aimed at a different structure. Which one applies depends on where the pain is coming from.
More than one can apply to the same patient, and the sequence is worked out from examination, imaging and where appropriate diagnostic blocks.
Figures are general ranges from the published literature and cannot be guaranteed for any one person. Reported success rates vary considerably between studies, and much of that variation comes down to how carefully patients were selected with diagnostic blocks beforehand. Temporary numbness over the skin of the treated area and a few days of soreness are common; serious complications are rare.
This is answered by examination and a diagnostic block, because a scan alone cannot show it. Please bring any MRI or CT you already have, and be ready to describe what makes the pain better and worse, which is especially useful here.