Many patients with spine pain want to try all options, if they can, before spine surgery. One nonsurgical treatment that is particularly effective for specific types of spine pain is radiofrequency ablation, says Erasmus Morfe, DO, a fellowship-trained physiatrist with Neurosurgery One.
“Many patients are familiar with steroid injections but may not know about radiofrequency ablation,” Morfe says. Morfe and his partner, Jason Peragine, MD, have been treating patients in the south Denver area for 15 years through Interwest Rehabilitation, which recently became a part of Neurosurgery One’s growing practice throughout Denver.
Radiofrequency ablation, also called rhizotomy, is a minimally invasive procedure that uses heat to ablate the nerve that is transmitting pain signals to the brain. It is most effective for facet joint pain and facet mediated pain. It also is effective in treating sacroiliac (SI) joint pain.
Correct Diagnosis is Key to Success
Radiofrequency ablation is best used for pain that is limited to the spine and buttock. “The prime candidate is someone with back pain more than leg or arm pain, and someone whose pain is worse with prolonged standing or extension but gets better with sitting.”
Making the right diagnosis is key to effective treatment. Dr. Morfe starts with an exam to check that the pain remains in the spine and gets worse with standing, extension or rotation. If those tests indicate the pain is related to facet issues, an X-ray and ultimately an MRI is needed for confirmation.
At that point, patients are referred for physical therapy as the initial treatment and may also be given steroid or cortisone injections to provide temporary relief while going through physical therapy for longer relief. If those measures don’t work, Morfe will make a test injection to temporarily numb the medial branch that connects to the facet joint to see if it brings relief. That test injection is made at the practice’s surgery center using fluoroscopy guidance (a type of real-time X-ray).
“If the patient gets relief with the test injection, then we go on to radiofrequency ablation,” Dr. Morfe explains.
A Year of Relief
The actual ablation is performed similarly to the test injection. After the patient is sedated, Dr. Morfe uses fluoroscopy to reach the affected medial branch nerve. Then he positions a heat probe on the targeted nerve and burns the nerve ending using radiofrequency current. The current destroys the portion of the nerve that transmits pain and disrupts the pain-producing signal.
The procedure takes about 30-40 minutes, with patients at the surgery center for about two hours from check-in to recovery. Patients will likely experience increased pain due to the procedure for about 1-2 weeks before the spine pain begins to diminish.
“We instruct patients to take it easy the day of the procedure, but they can return to work and regular activity the next day,” Morfe says.
The most common risk is temporary numbness at the injection site. Because the medial branches extend up into the skin, the heat from the radiofrequency may travel up those nerves and cause pain similar to a sunburn in some people who are particularly sensitive. Serious complications, such as infection or damage to the wrong nerve, occur in fewer than 1 percent of patients.
Radiofrequency ablation typically provides about 6-12 months of relief. In all patients, the nerves will grow back. In some, however, the nerves may grow back without reinstituting the pain. In patients whose pain returns, ablation can be repeated. The majority of insurance plans cover radiofrequency ablation.
If you are interested in finding out if a nonsurgical treatment can help relieve your spine pain, please make an appointment with Dr. Morfe or Dr. Peragine by calling 720-638-7500 or completing the form below.