Radiofrequency ablation (Rhizotomy) is a medical procedure that utilizes electric current to generate controlled heat, effectively interrupting nerve conduction on a semi-permanent basis. Typically, the nerves remain blocked for a duration ranging from 3 to as long as 24 months, with the average duration being 6-12 months.
Am I a Suitable Candidate for Radiofrequency Ablation?

Radiofrequency ablation is commonly recommended for individuals experiencing neck or back pain resulting from facet joint issues, such as arthritis or injury. In these cases, the procedure targets nerves directly connected to individual facet joints. Radiofrequency ablation is also employed to address persistent knee pain post-knee replacement surgery, certain types of headaches, and various other conditions. To be considered a candidate for radiofrequency ablation, you should have previously responded positively to diagnostic or trial injections. Most patients who undergo this procedure have typically explored other, less invasive treatment options, including anti-inflammatory medications, chiropractic care, or physical therapy.

What Are the Advantages of Radiofrequency Ablation?

Radiofrequency ablation disrupts nerve conduction, specifically targeting pain signal transmission. Consequently, it may lead to a reduction in pain and related symptoms. Approximately 70% of patients experience successful nerve blockade, resulting in pain relief. In some instances, the procedure may identify pain originating from other areas that may require further treatment.

How Long Does the Radiofrequency Ablation Procedure Take?

The duration of the procedure can range from twenty minutes to an hour, depending on the specific areas being treated.

How Is Radiofrequency Ablation Performed?

The procedure is performed in various positions based on the nerves to be ablated. Generally, when addressing facet joints in the cervical, thoracic, or lumbar spine, the patient lies face down (prone). Radiofrequency ablation is conducted under sterile conditions in a procedure suite or an operating room, with continuous monitoring of vital signs. The skin over the targeted area on the back is cleansed with an antiseptic solution, and local anesthetic is administered to numb the skin and deeper tissues. X-ray or fluoroscopy guidance is employed to accurately position the introducer needles. As nerves are not visible on X-ray, the introducer needles are positioned using anatomical landmarks that typically indicate nerve locations. Once the introducer needle is correctly positioned as verified by X-ray, a specialized electrically active probe is inserted through each introducer needle. A test involving electrical stimulation is performed to confirm the precise localization of the nerve before the actual radiofrequency ablation. This stimulation may produce sensations like buzzing, tingling, or thumping. Following confirmation of the correct nerve, local anesthetic is applied to numb the surrounding tissue, and the specialized electrically active needle tip is heated by passing an electric current through it. This effectively numbs or stuns the nerves on a semi-permanent basis. After the procedure, the needles are removed, and bandages are applied.

Is Radiofrequency Ablation Painful?

The procedure involves inserting introducer needles through the skin and layers of muscle and soft tissues, which can cause some discomfort. However, prior to inserting the introducer needles, the skin and deeper tissues are numbed with a local anesthetic using thin needles.

Is Sedation Required for Radiofrequency Ablation?

Radiofrequency ablation is typically performed under local anesthesia, but it can also be carried out with monitored anesthesia care (MAC) administered by an anesthesia specialist. Most patients receive some level of intravenous sedation, making the procedure more comfortable. The extent of sedation is tailored to the patient’s tolerance. It may be necessary for the patient to remain awake enough to communicate effectively with the physician during the procedure. However, some patients may receive sufficient sedation to experience amnesia and may not remember parts or all of the procedure.

What Can I Expect After Radiofrequency Ablation?

You may experience muscle soreness for up to two weeks following the procedure. Discomfort can generally be managed with ice packs. Over the first few weeks, you may notice that your pain has diminished significantly or is entirely gone. It might take up to four weeks to achieve substantial pain reduction.

What Should I Do After Radiofrequency Ablation?

After the procedure, you must arrange for a ride home as you may experience temporary numbness or weakness due to the local anesthetic. It is advisable to take it easy for a day or so, and you may be encouraged to apply ice to the treated area. Beyond that, you can engage in activities you can comfortably tolerate. Typically, a follow-up appointment is scheduled for four weeks after the procedure.

Can I Return to Work the Day After Radiofrequency Ablation?

In most cases, you should be able to resume work the day after the procedure. Some patients may experience soreness at the injection site(s), which could require a few days off work. The duration of time off may vary depending on individual discomfort.

How Long Do the Effects of Radiofrequency Ablation Last?

If successful, the effects of radiofrequency ablation can last from 3 months to as long as 24 months, with an average duration of 6-18 months. Since these procedures are not permanent, they can be repeated when the effects wear off.

Will Radiofrequency Ablation Be Effective for Me?

Predicting the effectiveness of radiofrequency ablation can be challenging. Generally, patients who have responded well to trial blocks tend to have better outcomes than those who had a less favorable response to diagnostic or trial injections.

What Are the Risks and Side Effects of Radiofrequency Ablation?

Radiofrequency ablation is generally considered safe. However, as with any medical procedure, there are potential risks, side effects, and the possibility of complications. The specific risks and complications depend on the nerves being ablated. Since the introducer needles must pass through the skin and soft tissues, patients may experience soreness and occasional bruising. Nerves targeted for ablation may be located near blood vessels or other nerves, increasing the potential for damage. The use of electricity during the procedure also introduces a risk of electrical burns. Careful attention is given to needle placement and electrical current during the procedure to minimize complications. Fortunately, serious complications or side effects are uncommon.