Radiofrequency Ablation


chronic pain pictureRadiofrequency ablation is a procedure that uses electric current or radio waves, which generates heat. When directed at certain nerves, this heat interrupts nerve conduction on a semi-permanent basis. The nerves are typically blocked for 6 to 9 months with radiofrequency ablation, although the effects could last for up to 18 months.

Who is a candidate for radiofrequency ablation?

Radiofrequency ablation is an effective procedure for patients with back and/or neck pain related to facet joint syndrome, spinal arthritis, and spine injuries. For these patients, radiofrequency treatments interrupt nerves that go to the individual facet joints.

This procedure is also used to treat SI Joint arthritis, occipital neuralgia, certain types of abdominal and pelvic pain, and additional indications emerge frequency, usually when the patient has tried and failed usual conservative treatments.

What happens before the procedure?

Before the procedure, a nurse will place an intravenous (IV) catheter in your arm, which is used for fluids and sedatives. The amount of sedation you receive depends on your tolerance and the doctor’s preference.

A nurse will attach monitoring devices to your body for monitoring blood pressure, heart rhythm, and oxygen levels. Radiofrequency ablation can take from 20 to 60 minutes to perform.

How is the radiofrequency ablation performed?

The patient is positioned on his/her stomach for procedures on the sympathetic nerves or spinal discs. Thspinal cord stimulator placemente skin is cleansed with an antiseptic solution. The doctor numbs the skin and tissues with a local anesthetic. Introducer needles are positioned using x-ray guidance and bony landmarks, which indicate where nerves are located.

A special needle tip is inserted, which provides electrical stimulation and produces a tingling sensation. Once the doctor is sure no big muscle groups are being stimulated, the tissue around the needle tip is numbed with an anesthetic. Then the needle tip heats the tissues with electric current, which deadens the nerves.

Will the procedure hurt?

There are layers of soft tissues, fat, and muscle that surround and protect the nerves. The radiofrequency ablation involves insertion of needles through these layers, so there is some pain involved.

However, the doctor uses an anesthetic to numb the skin and deeper tissues, which eliminates most pain. You should feel pressure sensations and a tingling when the electrical current reaches the nerves.

What should I expect after the procedure?

Radiofrequency ablation disrupts nerve conduction and pain signals. Around 70% of patients have good pain relief after the procedure. Initially, you will experience muscle soreness for 5 to 7 days.

Ice packs are recommended to relieve the discomfort. Be sure to have someone to give you a ride home, as you are not permitted to drive after sedation. You should rest the remainder of the day and only perform activities that are necessary. You are able to return to work the next day, however.

SI Joint RadiofrequencyHow many procedures will I have?

If the procedure works, the effects of radiofrequency ablation lasts anywhere from 3 to 18 months. If one procedure is not successful for relief of symptoms, the doctor may recommend that you have a repeat procedure after 2 to 4 weeks. Also, radiofrequency ablation is not a permanent treatment, so the effects do wear off.

What are the risks and complications of radiofrequency ablation?

As with most minimally invasive procedures, there are some risks and complications. With radiofrequency ablation, the risks depend on the site ablated. Soreness, bruising, and bleeding at the injection site can occur. Rare complications include nerve damage, infection, and electrical burns.

Does radiofrequency ablation work?

Radiofrequency ablation has been found to have positive effects for relieving SI joint and back pain in over 75% of patients for an average of 15 months. Additionally, when the pain relief wears off, a repeat procedure typically works just as well as the initial one did.

In a review of studies, several showed short-term pain relief after the procedure, and many others proved the long-term benefits of radiofrequency. In a study of 33 patients with SI joint syndrome, almost half of the patients had more than a 50% reduction in pain scores at 6 months post-procedure.

Resources

Ferrante FM, et al. Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Pain Med. 2004;5(1):26–32. doi: 10.1111/j.1526-4637.2004.04009.x

Hansen HC, McKenzie-Brown AM, Cohen SP. Sacroiliac joint interventions: a systematic review. Pain Physician. 2007;10:165–184.