Cervical Medial Branch Radiofrequency Ablation

Radiofrequency neurotomy is a means of destroying the nerves conducting pain.
Although the nerves will eventually grow back sometimes requiring further procedures
in the future, many patients derive up to 9-18 months of relief from this outpatient
procedure with about 20% having relief lasting over 2 years.

WHAT IS RADIOFREQUENCY (RF)?
Using a low voltage low wattage alternating current, energy is transmitted down an
insulated radiofrequency needle causing the tissues near the end of the needle to heat up.
This heat produces an interruption in the ability of nerves to transmit pain. Although RF
may be used in many areas of the body to reduce pain, the most common areas are the medial
branches to the lumbar or cervical facet joints after an appropriate diagnostic facet
block is performed.

Radiofrequency lesions to interrupt pain require placement of the needle tip directly
onto or within 1 millimeter of the nerve to be lesioned. Therefore, pinpoint accuracy is
required in order to effectively perform this procedure. High definition fluoroscopy is
needed to insure adequate placement and to insure the needle tip is far removed from
the nerves going to the arms and legs in the case of a medial branch RF. Other
commonly targeted sites for RF include the sphenopalatine ganglion inside the head as
a treatment for headaches, trigeminal ganglion just outside the brain as a treatment
for intractable severe facial pain, the nerves adjacent to the sacroiliac joint as a
treatment for sacroiliac arthopathy when sacroiliac joint injections have failed to
provide long term relief.

INDICATIONS FOR RF:
1. Lumbar arthritis, severe low back pain
2. Cervical arthritis, neck pain, or whiplash injury
3. Sacroiliac joint dysfunction/arthritis
4. Headaches (sphenopalatine ganglion)
5. Facial pain (trigeminal ganglion)
6. Abdominal pain (splanchnic nerve RF)

THE PROCEDURE: Usually performed with light sedation and local anesthesia. The procedure
itself varies from 15 min to over an hour depending on the complexity of needle
placement. The needles are placed through the skin which has been injected with local
anesthetic. The needles are then advanced to the target area under direct
fluoroscopic (x-ray) guidance. Stimulation with electrical signals are then used to
assure safety and that the needles are close to the target, then a small amount of local
anesthetic is injected into the target area to anesthetize the area before RF so that the RF
energy can be applied without any discomfort.

POST RF: Approximately 10% of the time there will be a flare up of “nerve” pain immediately
after the procedure and this lasts approximately 1-3 weeks. Most of the time, pain
reduction begins within a week to three weeks of the procedure. Use ice on the needle
entry site if needed for a few days after the RF. 60% of patients will derive 90% relief
and 90% of the patients will derive 60% relief.

COMPLICATIONS: Fluoroscopy makes the procedure safe when performing RF around
the spine. The most likely complications and side effects are usually minimal with
muscle soreness, etc. the typical post RF side effects. It is extremely rare to develop
infections, Bleeding, or nerve injury.

RF may be repeated up to every 3 months, however we recommend the longer interval,
the better. The results with RF vary, but are dependent on accurate diagnosis made
with an appropriate block before the RF lesion is created, the proximity to the target
nerve, etc. This is why we are meticulous with identifying the correct nerves with
x-ray guidance and testing stimulation prior to the RF.

RF is a standard pain management technique taught in all pain management fellowship
programs, has full FDA clearance, and has been used for over 40 years.