What Is Radiofrequency Ablation?
Facet joints are the small paired joints at the back of each spinal segment. When they wear down with arthritis, tiny nerves called medial branch nerves carry the pain signals to your brain. These nerves do not control leg or arm muscles, which is why they can be treated.
In radiofrequency ablation (RFA), a special needle carries a mild radiofrequency current to its tip. The current heats a small area of the medial branch nerve and interrupts its ability to send pain signals. The facet joint itself is not changed, but the pain message from it is quieted.
Over time the nerve usually grows back, so pain can return. When it does, the procedure can often be repeated if it helped the first time.
Performed under live X-ray (fluoroscopy) guidance in our in-office procedure room.
Who Is a Candidate?
RFA is for people with long-standing back or neck pain from the facet joints who have not improved enough with medication, activity changes and physical therapy. Before RFA, you typically have diagnostic medial branch blocks: short-acting numbing injections at the same nerves. If these relieve most of your usual pain for a few hours, RFA is more likely to help.
You may not be a candidate if you have an active infection, a bleeding problem, or certain implanted electrical devices. Tell Dr. Baskin about pacemakers, defibrillators, spinal cord stimulators and blood thinners.
What to Expect
You lie face down on the procedure table. Dr. Baskin numbs the skin and uses fluoroscopy, a live X-ray, to guide each needle alongside the targeted nerve. He may send a small test current to confirm the position and make sure no leg or arm muscles are affected. After the area is numbed, the nerve is heated for a short time at each level.
The procedure usually takes 30 to 90 minutes, depending on how many levels are treated. Some patients receive light sedation. You go home the same day and need someone to drive you.
Risks and Side Effects
RFA is generally well tolerated. Possible side effects and risks include:
- Soreness at the treatment sites for one to two weeks, sometimes described as a sunburn-like or burning feeling
- Temporary numbness or tingling of the skin over the treated area
- A short-term flare of your usual pain before improvement
- Rare risks such as infection, bleeding or nerve injury
Recovery
Most people return to light activity within a day or two. Relief often builds over two to four weeks as the treated nerves stop firing. When RFA works, relief commonly lasts from six months to a year or longer, though this varies from person to person.
The months of lower pain are a good window to build strength. Our physical therapists work in the same office and share your chart with Dr. Baskin, so a core strengthening and mobility program can start as soon as you are comfortable.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Medicare and most commercial PPO plans usually cover RFA of the facet joints when criteria are met. Those criteria commonly include documented pain for several months, a trial of conservative care, and positive diagnostic medial branch blocks. Coverage limits how often it can be repeated, and prior authorization is often required. HMO plans need a referral before your visit. Our team verifies your benefits when you call.
When to Talk to a Specialist
Call our office if back or neck pain has lasted three months or more, keeps coming back, or limits your daily life despite therapy and medication.
Go to the emergency room or call 911 for loss of bladder or bowel control, numbness in the groin, or sudden severe weakness in your legs or arms. After any procedure, seek urgent care for fever, spreading redness or drainage at the needle sites.
