Radiofrequency Neurotomy / Rhizotomy (ablation)
Radiofrequency (RF) neurotomy/rhizotomy 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.
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.
How it works
Radiofrequency ablation (yet another term for RF rhizotomy/neurotomy) is a nonsurgical, minimally invasive procedure that uses directed heat from electromagnetic wave energy, RF, to reduce or stop the transmission of pain through ablation, or “burning,” the nerve that is causing the pain, essentially eliminating the transmission of pain signals to the brain.
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.
Candidates for RF Treatment
RF Treatment can help many different causes of back pain, however it is most commonly used as a treatment for any of the following:
- Lumbar arthritis, severe low back pain
- Cervical arthritis, neck pain, or whiplash injury
- Sacroiliac joint dysfunction/arthritis
- Headaches (sphenopalatine ganglion)
- Facial pain (trigeminal ganglion)
- Abdominal pain (splanchnic nerve RF)
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.
After the Procedure
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.
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.