Lumbar Medial Branch Radiofrequency Neurotomy/ Radiofrequency Ablation (RFA)/ Rhizotomy

A straightforward Guide for Patients

What is a Lumbar Medial Branch Radiofrequency Ablation?

Radiofrequency ablation (RFA) is a minimally invasive treatment that uses controlled heat to interrupt pain signals coming from irritated facet joints in the spine. These joints can become inflamed—often due to arthritis—causing chronic low back or neck pain.

During RFA, a small amount of heat is applied to the medial branch nerves, which are the nerves responsible for sending pain messages from the facet joints to the brain. By treating these nerves, the pain signals are reduced, often providing long-lasting relief.

Purpose of the Procedure

RFA is typically performed after you have had medial branch block injections that temporarily relieved your pain. This helps confirm the facet joints as the pain source.

The goal of the radiofrequency neurotomy is to achieve:

  • Considerable Improvement in Pain
  • Relief that commonly lasts 6–12 months, and sometimes longer
  • Better ability to perform daily activities with less discomfort

This is an outpatient, non-surgical procedure.

What to Expect During the Procedure

  • Using live X-ray imaging (fluoroscopy), the provider places a thin needle near each targeted medial branch nerve.
  • A small amount of numbing medication is applied.
  • Radiofrequency energy is then used to create a precise heat lesion on the nerve.
  • This heat prevents the nerve from sending strong pain signals.

Following the procedure, you will be monitored briefly in recovery before going home.

Aftercare Instructions

  • No driving or operating heavy machinery for 24 hours if you received sedation.
  • Resume normal activities as tolerated. Soreness for 7–10 days is common.
  • It may take up to 1–2 weeks before you begin to notice pain relief.
  • No soaking in a bathtub, hot tub, or lake for 24 hours. Showering is fine.
  • The care team will call the next day to check on your recovery.

If Your Procedure Includes Sedation

To safely receive sedation:

  • No solid food for 8 hours prior.
  • You may have clear liquids up to 2 hours before the procedure. Examples include water, broth, clear juices without pulp, plain tea, and black coffee. (No creamers, no carbonated beverages.)
  • No gum, candy, or mints for 2 hours before the procedure.
  • The care team will review your medications before the appointment and tell you which ones to take that morning.

Failure to follow these instructions may require rescheduling the procedure.

Possible Risks

RFA is considered a safe, low-risk procedure. However, as with any medical treatment, complications can occur. Rare but potential risks include:

  • Temporary soreness at the treatment site
  • Skin infection or, in very rare cases, deeper infection
  • Headache from a dural puncture
  • Increased pain or symptom flare
  • Bleeding, including epidural hematoma (risk is higher if on blood thinners)
  • Nerve or spinal cord injury (extremely rare)
  • Allergic reactions to medications used
  • Other very uncommon complications such as seroma, renal issues, GI side effects, or aseptic meningitis
  • Inability to complete the procedure due to anatomical or technical difficulties

Please inform us if you take blood thinners, including:

Plavix (clopidogrel), Aspirin, Xarelto (rivaroxaban), Warfarin (Coumadin), Heparin, Lovenox (enoxaparin), Brilinta (ticagrelor), or others.

Insurance Requirements

Most insurance carriers require certain steps before approving RFA. These may include:

  • Minimum of 6 weeks of physical therapy or provider-directed Home Exercise Program
  • Pain present for greater than 4 months
  • Recent imaging, such as X-rays or MRI
  • Documentation showing that conservative treatments have not provided sufficient relief