Radiofrequency Lesioning: A Time-Honored Technique for Managing Spinal Facet Pain
Radiofrequency lesioning, also known as radiofrequency ablation, rhizotomy or neurotomy, has been used to treat a specific type of low back and neck pain since the 1970’s. The physicians at North Shore Pain Management are Massachusetts based experts in radiofrequency ablation, a technique that can provide 100% relief of pain arising from the facet joints of the spine.
Facet joint pain is common. Some studies estimate that up to 30% of chronic or recurrent low back and neck pain is due to degeneration of the facet joints of the spine. Facet joint pain is more common in older folks, in people who have had certain kinds of trauma to the spine like whiplash or a fall, and people who have had spinal fusion or other spinal surgery.
The facets are like little wings that stick up and down from the outside of every vertebra in the spine, connecting with the facets on the vertebrae above and below to form joints on both sides that stabilize the spine, while allowing bending and twisting movements. Like other joints in the body, the facet joints, also called zygapophyseal joints, can get damaged or worn out, and become painful.
The spine is complicated, and facet joint pain is sometimes difficult to diagnose accurately, but there are some signs and symptoms that indicate facet joint pain. At North Shore Pain Management, the providers will ask you several questions and do a focused physical exam to determine whether the pain you are having might be from facet joint degeneration. Imaging, such as X-rays, MRIs and CT scans, often do not show any abnormality of these tiny joints, but may be done to help rule out other causes of pain.
The best way of determining whether the facet joints are the source of low back or neck pain are diagnostic injections called medial branch blocks. During a medial branch block, the physicians at North Shore Pain Management will inject a small amount of a local anesthetic around the tiny sensory nerves of the involved facet joints. The relief from this diagnostic test will usually only last a matter of hours, but during this time we will want you to try doing activities that would normally be painful for you, and maybe try reducing your pain medication. A significant reduction of pain for the amount of time we expect the anesthetic to last indicates that the facet joints are the likely culprits. To be sure the facet joints are the problem, we will repeat the medial branch blocks. If we get a similar response the second time, we will proceed to radiofrequency lesioning, which can provide months or years of relief.
Radiofrequency lesioning uses heat generated by radio waves, emitted from specialized needles, to destroy the targeted sensory nerves. We use fluoroscopy, a type of live X-ray, to place the needles initially. You will have mild sedation for the procedure, but will not be completely knocked out, so that you can respond to questions to help determine that the needle is in the exact right spot. This significantly reduces the risk of problems and helps ensure a good result. We will use IV pain medication and a local anesthetic to keep you comfortable during the procedure. The procedure itself generally takes about 30 minutes, with additional time for preparation and recovery, and you’ll go home the same day. Anticoagulant medications, like warfarin or Plavix, do not usually need to be stopped.
The risk of major problems is very low, but radiofrequency lesioning (RFL) sometimes causes increased soreness, muscle cramping, and skin sensitivity or numbness, for up to 2 weeks after the procedure, usually easily managed with ice and topical or oral anti-inflammatory pain medications. These symptoms are more common when RFL is done in the neck, less common in the low back. Full relief usually occurs in 3-4 weeks, but can take up to 6-8 weeks. The nerves will eventually grow back, which sometimes results in the return of pain, but not always. If needed, RFL can be repeated, usually with the same results.
It’s not uncommon to have severe muscle cramping and spasm a few weeks after an RFL, as larger muscles start to move and stretch differently as a range of motion improves. The effects of repeated RFLs have not been well studied, but there is some evidence that there can be atrophy of the small muscles on either side of the spine that helps to stabilize the spine. It’s a good idea to combine RFL with physical therapy or yoga to help stretch and strengthen the core muscles to support and stabilize the spine and help muscles work more normally.
Radiofrequency lesioning provides relief of pain and improvement in function and quality of life to people with pain from facet joint degeneration. The providers at North Shore Pain Management, in both our Beverly and Woburn offices, can discuss radiofrequency lesioning and the possible pain management benefits for you.
At North Shore Pain Management we provide advanced, evidence-based, multidisciplinary and cost-effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.