Neuroablation
What is it?
Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique which employs radiofrequency waves to produce heat that damages the nerves transmitting pain signals to the brain.
How is it done?
You will be taken to the pre op area where trained nursing staff will get you ready for the procedure. Before the procedure an intravenous (IV) line may be placed in a vein in your arm and a local anesthetic and mild sedative may be used to relax you during RFA. You will be lying on your stomach. Only a small area over your back which requires treatment is cleansed and numbed. This procedure is performed under the guidance of fluoroscopy. The fluoroscope is a special kind of X-ray machine that helps doctors to visualize the placement of the needle electrode when it is inserted.
During the procedure, your doctor will direct a special radiofrequency needle electrode close to the facet joint in such a manner that the needle tip lies almost near to the medial branch nerve. Medial branch nerves are very small nerves that innervate the facet joints of the spine. Facet joints are the joints connecting the different vertebra of the spine to each other. The joints are present on both sides of the spine from the neck to the lower back. Once the needle and electrode placement are verified, a small amount of electrical current is sent through the needle so the nerve gets cauterized and destroyed, subsequently reducing the pain. The needle is removed and the injection site is covered with a dry, sterile bandage.
How long does it take?
The RFA procedure will take one to two hours to perform, depending upon the on the area of the body treated and number of treatments performed.
Pre-procedure Preparation
To prepare for radiofrequency ablation treatment, you should take the following precautions:
- Stop eating or drinking anything after midnight the night before your procedure. If you must take medications, take them with only a small amount of water.
- You will need to bring someone with you to take you home as you should not drive for at least 24 hours after the procedure.
- If you have diabetes you will have to adjust your dose of insulin. After the procedure you may take your diabetes medication.
- You may need to discontinue any blood thinning medications with the permission of your doctor.
- Do remember to bring with you all the medications that you have been taking so that you can take them after the procedure. Do not discontinue any medication without approval from your primary care physician.
Post Procedure protocol
Following radiofrequency ablation you may be able to go home within one hour. You may resume your normal diet. Do not drive or perform vigorous physical activity for the first 24 hours after the procedure. If pain increases, pain medication may be prescribed to make you comfortable. People who have problems with constipation should eat more high-fiber foods, drink plenty of fluids and if needed, use over–the–counter stool softeners. If you notice swelling and redness at the injection site, apply ice over a towel for 20 minutes every hour to the area to ease the discomfort.
Although the results of radiofrequency ablation vary, the pain relief achieved lasts from 3 to 12 months in most patients. In some cases the pain may return as the nerve regenerates. Your follow-up appointment will be scheduled a week or two after the procedure to see how well the treatment has worked.
What does it do?
Radiofrequency ablation is performed to treat painful facet joints in the spine that usually cause chronic low back pain, neck pain and pain related to the degeneration of joints from arthritis.
Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints, by performing a diagnostic facet joint injection.
Benefits
Benefits of radiofrequency ablation include:
- Longer lasting pain relief compared to facet joint injection
- Reduction of your pain
- Allows you to do more activities
- Allows you to reduce your pain medication intake
- Minimally invasive with no skin incision
- Short recovery time
Risks/Side effects
Radiofrequency ablation procedure is a safe treatment with low risks for complications. However, with any procedure there are possibilities of complications. Some risks and complications associated with radiofrequency ablation include:
- Infection: An infection can occur just below the skin, in a muscle, or in the facet joint. Check for signs of infection including fever and chills, redness, swelling, and increasing pain. Antibiotics are usually needed to treat the infection. If an abscess develops, surgery to drain the pus may be needed.
- Nerve damage: Nerve damage can occur if the needle electrode used during the procedure accidentally hits a nerve.
- Increased pain: Sometimes, the procedure can result in increased pain. Pain that starts several days after the procedure may indicate an infection.
- Allergic reactions: Allergic reactions may occur if you have allergies to the medications or contrast dye that may be used during the procedure. Pay close attention to any rashes and difficulty breathing as it may indicate need for emergency attention.
- Neuritis: Neuritis refers to an inflammation of the nerves resulting in pain and tenderness in the back. Injection of a local anesthetic along with a steroid medication can reduce inflammation around the nerve and ease your symptoms.
