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.
Neurosurgery One’s Erasmus Morfe, DO, a fellowship-trained physiatrist with Neurosurgery One, and 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.
FAQs about Radiofrequency Ablation
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Conditions We Treat
Am I a candidate for radiofrequency ablation?
Radiofrequency ablation is best used for pain that is limited to the spine and buttock. An ideal 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.
How do I know if radiofrequency ablation is right for me?
Making the right diagnosis is key to effective treatment. Our spine and pain management specialists at Neurosurgery One 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 spinal injections to provide temporary relief while going through physical therapy for longer relief. If those measures don’t work, our of spine or pain management specialists 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, FNASC, using fluoroscopy guidance (a type of real-time X-ray). If the patient gets relief with the test injection, then the specialist goes on with radiofrequency ablation.
How is radiofrequency ablation performed?
The actual ablation is performed similarly to the test injection. After the patient is sedated, a spine or pain management physician uses fluoroscopy to reach the affected medial branch nerve. Then the physician 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.
What is recovery like from radiofrequency ablation?
You will likely be out of recovery and able to return home within 2 hours from check-in. You will likely experience increased pain due to the procedure for about 1-2 weeks before the spine pain begins to diminish. You will be instructed to take it easy the day of the procedure but can return to work and regular activity the next day.
What are the benefits and risks of radiofrequency ablation?
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.