Radiofrequency Ablation

 
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   A lumbar radiofrequency ablation (RFA) is a procedure for treating low back, buttock, hip, and groin pain.    

What are lumbar facet joints?


 Facet joints connect the vertebrae, the bones of the spine.  They assist in guiding your spine when you move.  The low back area of the spine is called the lumbar region.  Facet joints are found on either side of the spine.  Each is about the size of a thumbnail. Lumbar facet joints are named for the vertebrae they adjoin and the side of the spine in which they are found.   Medial branch nerves are found near facet joints they transmit pain signals from the facet joints to your brain.

What is lumbar facet joint pain?


You may feel pain if a lumbar facet joint has become injured.  Sometimes it feels like regular muscle tension and other times it can cause severe pain.  The cartilage inside the joint may be injured and other times only connecting ligaments around the joint(s) are injured.  Facet pain also depends on what facet joint is affected.  Pain from lumbar facet joints occur in an area from your low back down to your buttock and thigh region.  

What is lumbar RFA?


RFA uses radiofrequency energy to disrupt nerve function.  When this is done to a lumbar medial branch nerve, the nerve can no longer transmit pain from an injured facet joint.

What happens before treatment? 


The doctor who will perform the injection will review your medical records and imaging studies to plan for the best location for these injections. Patients who are taking aspirin or blood thinners may need to stop taking the several days before the SIJ injection, doctor will provide specific instructions. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection. The injection is usually performed in an outpatient procedures suite that has access to fluoroscopy. You will need make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

What happens during treatment? 


Before your injection, you will be asked to sign consent forms, list medications you are taking, and list any allergies to medications. Procedure may last 15-30 minutes followed by a recovery period. Patients remain awake for these procedures. Sedatives can be given to help lessen anxiety.  The patient will be lying face down on the table, will receive a local anesthetic, which will numb the skin before the injection is given. If IV sedation is used, your blood pressure, heart rate and breathing will be monitored during the procedure. The physician will then insert a thin needle near the facet joint.  Fluoroscopy, a type of x-ray, will then be used to position the needle.  The doctor will then check to make sure it is located at the correct nerve by stimulating it.  This may cause muscle twitching or provoke some pain.  Once the needle correctly placed, the area will be numbed.  Radiofrequency energy will then be used to disrupt the medial branch nerve.  This often is repeated at more than one level of the spine. The needles and RF probes are removed upon completion of this procedure.

What happens after treatment? 


Most patients can walk immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home. Be sure to get plenty of rest for the rest of the day after the procedure.  You may feel sore for one to four days.  This is normal.  It may be due to muscle and nerve irritation.  Your back may feel numb, weak, or itchy for a couple weeks.  Full pain relief normally comes in two to three weeks.   You can typically return to work or normal daily activities they day following the procedure, but always check with your physician first. Typically patients will resume full activity the next day. If soreness around the injection site is present the following day, it may be relieved by using ice and taking mild pain medications such as Tylenol. The doctor’s office may want to follow up with you 21-28 days after the procedure to assess you response to this injection. You may be provided a diary to record you response to this procedure. You may notice a slight increase in pain after the numbing medicine wears off and before the procedure starts to take effect. 

What are the risks?


 The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare), corticosteroid medication induced side effects such as weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These usually resolve within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, or those who cannot temporarily discontinue anti-clotting medication) should consult their personal physician for a risk assessment.  With few risks, RFA is considered an appropriate nonsurgical treatment for some patients. Like most procedures where medications are injected, there is always a risk of allergic reaction. The medications that are commonly injected include lidocaine, bupivicaine, radiographic dye, and cortisone. Allergic reactions can be as simple as developing hives or a rash. They can also be life threatening and restrict breathing. Most allergic reactions will happen immediately while you are in the procedure room so that help is available immediately. Most reactions are treated and cause no permanent harm. You should alert your doctor if you have known allergies to any of these medications.  Any time a needle is inserted through the skin, there is a possibility of infection. Before any injection is done, the skin is cleansed with a disinfectant and the health care provider doing the injection uses what is called sterile technique. This means that the needle and the area where the needle is inserted remains untouched by anything that is not sterile. The provider may also use sterile gloves. Infections can occur just underneath the skin, in a muscle, or in the facet joint. You should watch for signs of increasing redness, swelling, pain, and fever. Almost all infections will need to be treated with antibiotics. If an abscess forms, then a surgical procedure may be necessary to drain the pus in the abscess. Antibiotics will also be necessary to treat the infection. 

What if the pain increases?


Not all injections work as expected. Sometimes, injections cause more pain. This may be due to increased spasm in the muscles around the injection. The increased pain is usually temporary, lasting a few hours or a few days. Once the medication has a chance to work, the injection may actually perform as expected and reduce your pain. Increased pain that begins several days after the injection may be a sign of infection. You should alert your doctor if this occurs.

How long can I expect pain relief?


Nerves regenerate after an RFA, but how long it takes varies.  Your pain may or may not return when the nerves regenerate.  If it does, another RFA procedure can be done