What is a Radio-Frequency Neurotomy (RF)?
A radio-frequency neurotomy is a treatment designed to decrease or eliminate pain from the spinal joints (facets) for six months to one year.
What is the Purpose of a Radio-Frequency Neurotomy?
A radio-frequency neurotomy is a musculoskeletal medicine procedure that is done to cauterize or burn the small, short nerves that carry pain from the spinal facet joints to the spine, interrupting the pain pathway.
Are you a Candidate?
Anyone who has had pain relief with either a facet joint injection and a facet nerve block or two facet nerve blocks is a candidate. The standard of care is to block the pain pathway twice with blocks before the RF is done. The success rate is 90%, if the patient has had at least 50% relief of pain from the two prior blocks before the RF is done, and this can also be used as part of a larger regenerative medicine strategy.
How is the Procedure Performed?
The patient lies face down on the procedure table. X-ray equipment (fluoroscopy) is always used. The site to be injected is numbed with local anesthetic (Novocain) and two needles are directed to the target area. Electrodes are inserted into the needles and motor stimulation is done to ensure that the spinal nerve is not being stimulated.
This is a safety factor to ensure the correct nerve is being burned. Local anesthetic is then injected and radio waves are fed through the electrode, which causes the end of the needle to become very hot. A weak steroid (synthetic cortisone) is sometimes injected after the burn to reduce the inflammation, and hopefully the post-procedure discomfort.
Will the Procedure be Painful?
This is usually thought to be a painful procedure. The results are better if larger needles are used. The painful part of the procedure is the positioning of the needles. Since the area is numbed, the actual burning is not painful. Almost everyone is encouraged to get intravenous sedation. Typically, everyone experiences discomfort after the procedure, which can last up to six weeks, but usually less. Post-procedure pain medication is usually required.
What are the Risks and Side Effects?
You may experience a sensation similar to a sunburn following the procedure. This is normal and temporary. If severe, additional medications to treat this side effect are available.
Complications for this procedure are low. Whenever a needle enters the skin, bleeding or infection can occur. If steroid medication (synthetic cortisone) is used, there may be some side effects from the medication.
Side effects from the steroid medication include flushing, insomnia, increased heart rate, some swelling, and a rise in blood sugar and occasionally blood pressure. These side effects are usually mild and temporary, but a rare patient may find the “steroid effect” quite unpleasant. If you are diabetic or have unstable blood pressure, use of steroids can be eliminated.
The most serious side effects from intravenous sedation is sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose.
You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.
More serious but extremely rare risks include nerve injury, paralysis, weakness or death. These complications have never occurred in our practice.
How Long Does it Take for the Procedure to Work?
You should start to feel relief as soon as the post-procedure pain starts to wear off.
What Restrictions Will I Have on the Day of the Procedure?
There are no specific restrictions associated with the procedure. If you have sedation, you will not be allowed to drive, operate machinery, or make legal decisions until the next day. You should not soak until the skin is healed. You may shower the same day.