Radiofrequency Ablation (Rhizotomy)

What is radiofrequency ablation? 
Radiofrequency ablation is a procedure using electric current to generate sufficient heat to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-12 months, although it may last as short as 3 months or as long as 24 months or longer.

Am I a candidate for radiofrequency ablation?
Radiofrequency ablation is most commonly offered to patients with neck or back pain from facet joint problems like arthritis or injury. For these patients radiofrequency ablation is used to interrupt nerves that go directly to the individual facet joints. Radiofrequency ablation is also used in patients with continued knee pain following a knee replacement, some forms of headaches and several other conditions.  To be a candidate for radio frequency ablation you must have responded well to diagnostic or trial injections. Most patients who undergo radiofrequency ablation have typically tried other, more conservative, treatments such as anti-inflammatory medication, chiropractic care or physical therapy.

What are the benefits of radiofrequency ablation?
Radiofrequency ablation disrupts nerve conduction, specifically interrupting the conduction of pain signals. In turn, this may reduce pain, and other related symptoms. Approximately 70 percent of patients will get a good block of the intended nerve relieving the pain that the blocked nerves control. Sometimes after a nerve is blocked, it becomes clear that there is pain from other areas as well, which may also need to be treated.

How long does radiofrequency ablation take?
The procedure can take from twenty minutes to an hour, depending upon the areas to be treated.

How is radiofrequency ablation actually performed?
Radiofrequency ablation is done in different positions depending on the nerves to be ablated but typically performed with the patient lying on the stomach when working on the facet joints, of the cervical, thoracic or lumbar spine. The procedure is done under sterile conditions in a procedure suite or an operating room. The patients vital signs are monitored during the procedure. The skin on the back is cleaned with antiseptic solution and the skin is numbed with a local anesthetic. X-ray or fluoroscopy is used to guide placement of the introducer needles. Since nerves cannot actually be seen on x-ray, the introducer needles are positioned using bony landmarks that indicate where the nerves usually are located. Once the introducer needle is in a good position by X-ray, a special electrically active probe is inserted into each introducer needle. With the probe tip in good position, a test procedure using electrical stimulation is done to ensure correct nerve localization before the actual radiofrequency ablation. This electrical stimulation may produce a buzzing, tingling, or a thumping sensation. Once the correct nerve is confirmed, the tissue around the needle tip is numbed with local anesthetic. The tissues surrounding the special electrically active needle tip are then heated when electric current is passed through it. This effectively numbs/stuns the nerves semi-permanently. Once done, the needles are removed and bandages are applied.

Will the radiofrequency ablation hurt? 

Layers of muscle and soft tissues protect nerves. The procedure involves inserting introducer needles through skin and those layers of muscle and soft tissues, so there is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the introducer needles.

Will I be “put out” for a radiofrequency ablation?
This procedure is done under local anesthesia but can also be performed under MAC sedation given by an anesthesia professional. Most of the patients will receive some intravenous sedation, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is sometimes necessary for you to be awake enough to communicate easily with the physician during the procedure. However, some patients receive enough sedation that they have amnesia and cannot always remember parts or all of the actual procedure.

What should I expect after the radiofrequency ablation?
Initially there will be muscle soreness for up to two weeks afterward. Ice packs will usually control this discomfort. After the first several weeks, your pain may be gone or quite less. It may take up to 4 weeks to obtain significant pain reduction.

What should I do after the radiofrequency ablation?
You must have a ride home following the procedure. We advise the patients to take it easy for a day or so after the procedure. You will be encouraged to apply ice to the affected area. Otherwise, you can perform any activities that you can reasonably tolerate. You will typically have a follow-up 4 weeks following the procedure.

Can I go to work to work the next day?
You should be able to return to work the next day. For some patients, soreness at the injection site or sites may cause you to be off work for several days.

How long will the effects of the radiofrequency ablation last?
If successful, the effects of the radiofrequency ablation can last from 3 to upwards of 24 months, with a typical range of 6-18 months.

How many radiofrequency ablations do I need to have?
Because these are not permanent procedures, they can be repeated when the effect wears off.

Will the radiofrequency ablation help me?
It is sometimes difficult to predict if the radiofrequency ablation will indeed help you or not. Generally speaking, the patients who have responded well to trial blocks will have better results than those who responded less well from diagnostic or trial injections.

What are the risks and side effects of radiofrequency ablation?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The risks and complications are dependent upon the sites that are ablated. Since the introducer needles have to go through skin and soft tissues, there will usually be some soreness and occasionally bruising. The nerves to be ablated may be near blood vessels or other nerves that can be potentially damaged. Electricity is also used during the procedure raising the possibility of an electrical burn. Great care is taken when placing the radiofrequency needles and using the electrical current, but sometimes complications occur. Fortunately, serious complications or side effects are uncommon.

 

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