What is Radiofrequency Ablation

  • Radiofrequency ablation (RFA) is a minimally invasive treatment that uses radio waves to heat and temporarily disable small nerves that send pain signals.
  • These nerves—called medial branch nerves—come from the facet joints, which are small joints connecting each bone in your spine.
  • When these joints become irritated or arthritic, they can cause chronic neck or back pain.
  • RFA creates a small heat lesion on the nerve so it can no longer transmit strong pain signals, often giving long-lasting relief (usually 6–12 months, sometimes longer).

Goal of the Procedure

  • RFA aims to provide at least 50% relief of chronic neck or back pain.
  • Relief often lasts 6–12 months.
  • This procedure is usually offered after medial branch blocks confirm that the facet joints are the source of your pain.
  • It is performed in an outpatient setting and does not require surgery.

The Procedure

  • You may receive IV sedation to help you relax.
  • A nurse will place an IV before the procedure.
  • You will be brought into a sterile procedure room and asked to lie face down or on your side.
  • Using X-ray guidance:

    • The skin is numbed.
    • A small needle is placed near the medial branch nerve at each facet joint.
    • The nerve is numbed with local anesthetic.
    • A controlled electrical current then creates a heat lesion, which stops the nerve from sending strong pain signals.
  • Afterward, you will spend a short time in recovery before going home.

After the Procedure

Follow the recovery instructions provided at discharge:

  • If you received sedation:

    – Do not drive or operate machinery for 24 hours.
  • Activity:

    – Resume activities as tolerated; mild soreness for 7–10 days is common.

    – Pain relief may take up to 7–10 days to begin.
  • Bathing:

    – Do not soak in a bathtub, pool, or lake for 24 hours. Showers are okay.
  • The care team will call you the next day to check on your recovery.

If Your Procedure Includes Sedation

  • No solid food for 8 hours before the procedure.
  • Clear liquids are allowed up to 2 hours before. Examples:

    – Water, broth, pulp-free juices, tea, black coffee.

    – No carbonated drinks.
  • No gum, candy, or mints for 2 hours before.
  • The care team will contact you ahead of time to review your medications.
  • Not following these instructions may require rescheduling the procedure.

Potential Risks

RFA is considered safe and minimally invasive, but all procedures carry some risks. Rare but possible side effects include:

  • Pain or soreness at the injection site
  • Infection (skin or epidural)
  • Stroke (very rare)
  • Dural puncture or spinal fluid leak (causes headache when upright, relieved when lying flat)
  • Temporary increase in pain
  • Bleeding or epidural hematoma
  • Nerve injury (extremely rare)
  • Allergic reaction to medications (local anesthetics or contrast dye)
  • Other rare complications: epidural fibrosis, aseptic meningitis, GI issues, kidney problems, seroma
  • Difficulty completing the procedure due to anatomy or technical issues

Important:

Please inform us if you take blood thinners, including:

Plavix, Aspirin, Xarelto, Coumadin/Warfarin, Rivaroxaban, Heparin, Lovenox, Brilinta, or others.

Insurance Requirements

Before approving RFA, most insurance companies require:

  • Physical therapy or provider guided home exercise program– at least 6 weeks
  • Pain present for at least 3 to 4 months
  • Imaging, such as X-rays or MRI
  • Documentation showing that other conservative treatments have not provided relief