What is radiofrequency neurotomy?
Radiofrequency neurotomy is a nonsurgical procedure to help relieve chronic back pain. (Pain is described as chronic if it lasts for more than 12 weeks, even after treatment or medication.) It is a minimally invasive procedure that uses heat to destroy a nerve that is causing chronic pain. This procedure, also called radiofrequency ablation, is usually performed on an outpatient basis (the patient goes home the same day).
How does radiofrequency neurotomy work?
Nerves within the spine are the source of chronic back pain. Nerves are found in the vertebrae (the bones of the backbone, or spine), ligaments (the fibrous tissue that connects bones), and facet and sacroiliac joints, for example. Nerves are how pain signals travel to the brain.
Most chronic back pain usually comes from two joints of the spine:
- Facet joints are pairs of small joints between the vertebrae in the spine and hold the spine upright. These joints give the spine flexibility and allow movement of the back, such as twisting and bending. Two small nerves, called medial branch nerves, are connected to the facet joints and send a signal to the brain that there is pain coming from the joints.
- Sacroiliac joints are found at the bottom of the spine, right above the tailbone. Lateral branch nerves that are connected to these joints send pain signals from the spine to the brain.
During a radiofrequency neurotomy procedure, the heat comes from a small electrical current that travels through a needle that has been inserted next to these small nerves. The heat is directed at the nerve that is causing the pain, so that nearby healthy nerves are not damaged during the procedure.
What conditions are treated with a radiofrequency neurotomy procedure?
The radiofrequency neurotomy procedure can help patients who suffer from:
- Osteoarthritis, a chronic condition of the joints in which the cartilage, the smooth material between the joints, wears away;
- Spine conditions that are a result of a traumatic injury, such as a car accident in which the spine is injured.
What happens before a radiofrequency neurotomy procedure?
The doctor will examine the patient, review his or her medical history, and ask questions to find out what may be causing the pain. X-rays or other imaging tests are typically ordered to visualize (picture) the anatomy, determine the levels with arthritis and to rule out any other issues.
Following this, two sets of diagnostic blocks, using local anesthetic only, are typically performed in order to confirm the source of the pain, the correct levels and the potential degree of relief. If the diagnostic blocks do not provide significant relief, the doctor will not proceed with a radiofrequency neurotomy. However, if the response to the diagnostic blocks is favorable, the doctor may recommend radiofrequency neurotomy as a treatment to ease the back pain.
What happens during a radiofrequency neurotomy procedure?
During a radiofrequency neurotomy procedure:
- The patient is placed on his or her stomach on a special X-ray table and the skin over the back is cleaned.
- The correct areas for the injections are identified and the skin is marked.
- The skin at the injection sites on the back is numbed.
- The doctor then inserts a needle into the patient’s back and guides the needle, using a fluoroscopy (a live X-ray), to the nerve that is causing the pain.
Once the needle has reached the site where the nerve is typically located, the doctor will do a test to confirm that the needle is near the nerve and not near a motor or sensory nerve. When the sensory testing current passes through the needle and into the nerve, the patient will feel some pain in the back, which may move to the buttocks and down the back of the thigh. During the motor testing, the patient may feel some discomfort from back muscles that will twitch.
Once the correct needle position is confirmed, local anesthetic is injected through the needle to numb the area. Once the local anesthetic has had time to work, a small amount of electrical current is passed through the needle to generate localized heat. The heat kills the nerve and stops it from sending pain signals to the brain.
What happens after a radiofrequency neurotomy procedure?
Shortly after the treatment, the patient can go home to rest and resume light activity. The patient should not drive or do anything strenuous after the procedure. After a day or two, the patient can resume normal activities.
A few days after the procedure, the patient may still feel soreness in the back where the procedure took place. This pain is usually caused by muscle spasms, and the areas where the needles were inserted. That pain is normal and may last for up to a week.
If necessary, the doctor may prescribe medication for the soreness and pain. The doctor may also recommend physical therapy to help the patient regain strength and flexibility in his or her back and legs.
Risks / Benefits
What are the advantages of radiofrequency neurotomy?
Radiofrequency neurotomy is a nonsurgical procedure. The recovery period is fairly short, and after a day or two of rest, the patient can usually resume regular activities.
What are the side effects and risks of radiofrequency neurotomy?
During the procedure, the patient will feel some back pain, similar to what he or she experienced before the procedure.
There may also be a burning sensation on the back, similar to sunburn pain. In some patients, this pain may remain for a week or two after the procedure. The doctor may recommend placing ice on the back to cool it.
Some patients may feel some numbness in the back where the needle went into the skin. If necessary, the doctor may prescribe medication to help with the pain and numbness.
Is radiofrequency neurotomy safe?
While complications from this procedure are rare, permanent nerve damage or pain can occur on occasion. In some cases, the original back pain may get worse.
Recovery and Outlook
What is the long-term prognosis (outlook) for patients after a radiofrequency neurotomy?
Every patient is different, and radiofrequency neurotomy may help some and not others. For some patients, the relief may be temporary, lasting anywhere from a few months to a couple of years, before the pain eventually returns. Others may notice limited pain relief.