Radiofrequency Neurotomy for facet joint pain

Percutaneous Radiofrequency Neurotomy (RF) is a long-term pain-relieving treatment for neck pain and back pain.  It is not a cure and nor is it effective for every patient, only for those patients whose pain is caused by facet joint damage. 

 

RF is a minor surgical procedure.  A needle is introduced through the muscles of the neck or back.  Under X-ray control and guidance, the electrode is positioned so that the tip lies alongside the nerves which carry pain messages from facet joints to the brain.  The electrode is then heated to 80º C for 90 seconds.  This is performed several times along the tract of the nerve to ensure the nerve is ablated.   This does not destroy the nerve but prevents pain messages from reaching consciousness until the nerve regrows. 

 

WHO IS ELIGIBLE FOR RADIOFREQUENCY ABLATION 

Patients with back pain and referred buttock or leg pain who have been proven to have cervical or lumbar facet joint pain by means of at least two positive local anaesthetic diagnostic nerve blocks.

 

RISKS

These can be divided into early and late risks / side-effects:

Early:

• As with any procedure in which skin is penetrated there is a small risk of infection.

• Allergic reaction to local anaesthetic.  (This should have been detected during the diagnostic block injections).

• Developing an area of hypersensitive skin for a few days up to a few weeks following the procedure.  This can range from a nuisance to a burning disabling pain, which always settles spontaneously. 

• There is a potential risk of damaging other tissues and thereby causing weakness or numbness in the limb.  This has never happened in the 20 year experience of the Newcastle Pain Management & Research Group whose protocols are being followed here, nor has it happened in New Zealand over the last 15 years.  The risk is minimised by the use of X-ray visualisation and by the fact that the patient remains awake during the whole procedure.

• Radiation exposure especially if there is any chance you are pregnant.

• Failure of the procedure.  The Newcastle & Auckland team success rate is 85%.

Late:

• Damage to joint (because of lack of nerve supply).  This risk is reduced by the fact that the nerve supply to all the discs and to the rest of the facet joints of the back remain intact. 

• “Phantom pain” or “neuropathic pain” or neuroma formation.  These terms are used to describe types of pain often encountered where nerves have been cut or destroyed, often after a period of initial pain relief.  This should not happen after Radiofrequency Ablation as the nerve is neither cut nor destroyed in this procedure.

• Eventual failure of the procedure after repeated Radiofrequency Ablations.  It is not known how many times the procedure can be successfully repeated.

 

LENGTH OF RELIEF

The range of responses with this procedure has been from no relief to long term relief.  The average duration of relief at the present stage of knowledge, is 9 to 15 months.  The length of relief depends on the rate at which nerve regrowth occurs, and how effectively the nerve has been ablated by the procedure. This can differ between different people, so it is difficult to predict this accurately.

 

DAY OF PROCEDURE

You will be treated at the same place as where you had the two sets of initial nerve blocks.  The procedure usually takes 1 hour per joint treated. You will need a friend or relative to drive and accompany you home.  You can eat and drink before the procedure.

 

Adequate amounts of local anaesthetic are used throughout the procedure to maximise comfort.  The patient needs to be awake throughout the procedure so he / she can inform the doctor if they feel discomfort associated with the procedure. 

 

FOLLOWING THE PROCEDURE

Shortly following the Radiofrequency ablation procedure the doctor will review you ensure you are feeling OK to leave.  You may need your usual pain relief medications and ice packs for the first few days to prevent swelling and bruising.

 

The day after the procedure you will be contacted by telephone to inquire about your progress and to answer any queries.  It may take a few weeks to tell if the procedure has been successful but most people can tell within the first few days.

 

If you are on warfarin or other blood thinners – please ring The Musculoskeletal Institute because special arrangements need to be made before the procedure

 

If you have any further questions regarding the booking, pricing or the procedure please e-mail The Musculoskeletal Institute at office@msk-institute.co.nz