Radiofrequency ablation, also known as neurotomy when applied to the neck, back and spine, is a minimally-invasive procedure that uses radiofrequency energy to disrupt specifically-targeted nerves from sending pain signals to the brain. This procedure is used to help manage pain in the facet joint and sacroiliac joint caused by injury or degenerative diseases, like arthritis, when optimal outcomes are not achieved through physical therapy or medication.
Facet joints are stabilizing joints between and behind vertebrae in the spine that allow for flexible movement. The sacroiliac joint connects the triangular bone at the bottom of the spine (sacrum) to the pelvic bone, (iliac crest). Pain associated with the sacroiliac joint and facet joints can be debilitating and diminish quality of life.
Radiofrequency ablation techniques are applied in a variety of methods to treat different conditions throughout the body.
About the Procedure
Patients are sedated and the skin on the back or neck is numbed with a local anesthetic. Using a special X-ray for guidance, the physician then inserts a needle through the skin in the back adjacent to the medial nerves on the facet joints, or the or lateral nerves along the sacroiliac joint. A weak electric current is passed through the needle to help identify the targeted nerves. This is called a lateral branch or medial branch nerve block.
A local anesthetic is then used to numb the targeted nerves before heat emitted from the radiofrequency is used to create a lesion on the nerve, disrupting its ability to send pain signals to the brain.
The procedure lasts typically between 30 to 90 minutes. The skin puncture from the needle is covered with a bandage once the needle is removed.
Recovery and Physical Therapy
Radiofrequency ablation is usually an outpatient procedure, with most patients are discharged the same day as surgery. Patients are strongly advised not to drive or engage in strenuous activity for at least 24 hours.
It may take one to two weeks for the ablated nerve to stop sending pain signals to the brain. Patients may also feel diminishing pain or numbness at the point of injection in the first week or two following the procedure. Complete pain relief typically occurs within three weeks of the procedure and may continue if pain does not recur when the nerve regenerates.
A physical therapy regimen may be recommended for patients who had previously limited their movement because of the pain that required treatment.
Neck and Spine Regions
In medical terminology, the spine is divided into regions that correspond to their position along the vertebrae in the backbone. These sections are:
- Cervical vertebrae in the neck (C1-C7)
- Thoracic vertebrae in the chest-level or upper back segment (T1-T12)
- Lumbar vertebrae in the lower back (L1-L5)
- Sacral vertebrae in the pelvic region (S1-S5)
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