Radiofrequency ablation (RFA) is a medical procedure where an anatomical structure such as a tumor, a portion of the electrical conduction system of the heart, or a pain-generating structure is ablated or cauterized using the heat generated from a high frequency alternating current. One important advantage of RF current is that it does not directly stimulate nerves or heart muscle and can therefore be used without the need for general anesthesia. RFA procedures are performed under image guidance (such as x-ray, CT scan or ultrasound) by an interventional pain specialist, an interventional radiologist, a gastrointestinal or surgical endoscopist, or a cardiac electrophysiologist.
In the field of pain management, and specifically in the management of spine-related pain, RFA has exploded in recent years and with excellent patient outcomes. RFA, also referred to as rhizotomy, may be used to treat severe chronic joint-related pain in the low back (lumbar spine), mid-back (thoracic spine), neck (cervical spine), and sacroiliac joints.
In these regions of the spine, radiofrequency waves are used to apply heat to specific nerves called medial branch nerves, which surround and innervate the facet joints of the spine. These facet joints are the articulating joints in the spine, which, much like other joints in the body, consists of two bones articulating via a fluid-filled joint space and surrounded by a “synovial” joint capsule. These joints are largely what allow the human skeleton to flex, extend, rotate and, just the same as other larger joints in the body, are equally prone to developing arthritis and causing pain. Facet joint arthritic pain is thought to be a largely under-diagnosed pain condition.
The first step in treating this arthritic spine pain is establishing a clear diagnosis, which is the key to the correct and safe utilization of the RF technology. This is done by having a a pain specialist perform a facet joint block. In this procedure, the pain specialist uses an x-ray machine called a fluoroscope to identify the specific facet joints of interest, and subsequently injects a local anesthetic, or numbing agent, directly into the target area. The target area is usually the anatomical location of the medial branch nerve, which is known to carry the “pain signal” directly from the arthritic facet joints to the spinal nerves, spinal cord and brain. If a facet joint injection or “facet block”, results in significant, or greater than 50%, reduction in the patient’s usual spine pain, then RF is usually an appropriate next step in the treatment plan. Some practitioners will perform a second diagnostic facet injection before proceeding with the actual RFA.
The RFA procedure is performed in a similar manner to the facet block itself, instead using special RF needles. These RF needles have tips with the ability to contain specific RF probes and generate heat through the needle-tips. The RFA proceeds as follows: First the needles are placed using the same x-ray guided technique as the facet block, and the active RF probes are inserted through the needle cannulas. Next a safety check is performed (before the actual RF or heating procedure) during which the probes are stimulated at different frequencies, usually 50Hertz and 2Hertz, and the physician and patient establish that reproductive stimulation is felt specifically at the location of their spine pain.
After this safety check, an anesthetic agent is injected through the needle tips to numb the structures before the actual RF or heating process. Finally, the RFA is performed, usually at a temperature of 80 degrees centigrade for 60 to 90 seconds. By generating heat around the nerve, its ability to transmit pain signals to the brain is destroyed, thus ablating the nerve. After the RFA procedure and just before the needles are removed, some practitioners inject a steroid to aid with the healing process and prevent a pain “flare-up” that rarely occurs.
The patient is sent home soon after completion of the procedure. Usually pain relief is felt shortly after the procedure, though a certain level of discomfort from the procedure itself is normal and expected.
RFA is a minimally invasive procedure which can be performed in the office or in an outpatient surgical center. The patient is awake during the procedure, so risks associated with general anesthesia are avoided. RFA is an excellent treatment for arthritic related spine pain in the correctly chosen patient candidate and in the hands of an experienced pain practitioner. Pain relief may typically last from 6 to 12 months, as the medial branch nerves do regenerate over time, and so pain normally “grows” back as well.
RFA is a longer term solution than many other pain procedures and is a less invasive option than spine surgery. Spine pain stemming from facet joint arthritis is a largely under-diagnosed pain condition and may be successfully managed with RFA. Ask your pain doctor if RFA might be appropriate for you.