Radiofrequency Ablation

What radiofrequency ablation is

The small facet joints at the back of your spine are lined with cartilage and, like knees, they wear out. Arthritic facet joints cause deep, aching, one-sided neck or low back pain that is worse with standing, twisting or leaning back, and better when you sit or bend forward.

Each facet joint gets its pain signal from tiny nerves called medial branches. Radiofrequency ablation — also called rhizotomy or facet denervation — places a special needle next to those nerves and heats a small area to about 80°C for roughly 90 seconds. The heat creates a lesion that stops the nerve from carrying the pain signal.

These nerves only carry sensation from the joint. They do not control muscle strength or leg movement, which is why the procedure relieves pain without weakening you.

Why we test first

Ablation is not the first step. Before we burn a nerve, we prove it is the right nerve. That means one or two diagnostic medial branch blocks: a small amount of numbing medication placed at the same targets. If your pain drops substantially — generally 80% or more — while the anesthetic is working, the facet joints are confirmed as the source and ablation is likely to help.

If the diagnostic blocks do not relieve your pain, we do not proceed. That is a good outcome, not a failure: it tells us to look elsewhere instead of performing a procedure that would not have worked.

The procedure itself

• You lie face down; the skin is cleaned and numbed with local anesthetic.
• Under fluoroscopy, insulated needles are positioned at each medial branch.
• Test stimulation confirms position before any heat is applied.
• More local anesthetic is given, then each site is heated for about 90 seconds.
• Several levels are usually treated in one session, on one side.

Recovery

Expect a sore, sunburn-like ache in the treated area for one to two weeks. Some patients feel worse before better during that window — this is expected as the nerves finish dying back. Ice for the first 48 hours, then heat if it feels better.

Relief usually settles in between one and three weeks. Most people are back to normal activity within a couple of days and back to full exercise inside two weeks.

How long it lasts and repeating it

Medial branch nerves regenerate. When they do — commonly at six to twelve months, sometimes longer — the pain can return. The procedure can be repeated, and repeat ablations tend to work about as well as the first.

We use the relief window productively. The months when your pain is down are the months to build core strength and mobility, so that each cycle leaves you stronger and less dependent on medication.

Risks

Reported effects include temporary increased pain, bruising or soreness at needle sites, a small patch of numb skin, and uncommonly a temporary painful neuritis. Infection and bleeding are rare. Permanent nerve injury is very rare with image guidance and test stimulation.