What is Radiofrequency Neurotomy of Facet Joints?

Facet-RFNA radiofrequency neurotomy or ablation is a procedure performed on the nerves that supply the painful joints. These joints may be subject to degeneration particularly in the low back or neck where they can be the cause of pain and sometimes referred pain to the arms or legs. The cause of the pain may not be evident on a scan. Some of the joints suitable for radiofrequency neurotomy include facet joints and sacroiliac joints.

The ablation decreases pain signals being sent to your brain by interrupting the nerve supply to the joints. This is done by placing a needle beside the nerve. Next, a radiofrequency signal is passed through the needle causing the tip to heat up to approximately 85 degrees Celsius. This cauterizes the nerve and stops the pain signals.

Patients may be offered this procedure following a positive response to medial branch blocks or facet joint injections. A positive response to test injections may only be for hours.

 

How long could the pain relief last after Radiofrequency Neurotomy of Facet Joints?

Pain relief varies for every patient, and can last from 3 to 24 months. However, the average pain relief is 9-12 months.

It is important to note that this is not a permanent solution, and is not always effective. Nerves eventually recover and pain can return. If this occurs, it may be appropriate to repeat the procedure.

Please note that this procedure does not treat underlying arthritis or degeneration.

 

Will I be awake during the procedure?

While most people choose sedation, it is not compulsory. However, sedation is often chosen to avoid discomfort. While it is not guaranteed, you will likely have little or no memory of the procedure.

 

Is the procedure painful?

You will be given local anaesthetic at the beginning of the procedure. Once this wears off, you may experience some discomfort or pain.

 

How do I prepare for the procedure?

It is important to make sure your medical specialists are aware if you are:

  • Taking blood thinners
  • Diabetic
  • Pregnant or have the chance of being pregnant
  • Have any allergies
  • Have been feeling unwell or suffering from an infection
  • Are implanted with a medical device.

 

Prior to undertaking the procedure, medical specialists may advise you to:

  • Ensure you have someone to accompany you home
  • Avoid drinking any fluids 3 hours before the procedure. You can drink clear fluids up until 3 hours before the procedure starts.
  • Do not eat any foods for 6 hours before the procedure
  • Continue taking usual medications, unless otherwise advised to stop.

 

What does the procedure involve?

It’s important to understand what you can expect to happen on the day of your procedure:

  • You will arrive and complete the necessary paperwork
  • You will change into a hospital gown
  • If you have elected to have sedation, you will be required to have a conversation with an anaesthetist
  • If needed, a small cannula will be inserted into one of your veins
  • You may be given a mild sedative
  • You will have your heart rate and blood pressure continually monitored throughout the procedure
  • Lying face down on an x-ray table, you will have the skin over the injection area cleaned with antiseptic solution. Sterile drapes will also be applied
  • You may have a local anaesthetic injected into your skin
  • Using an x-ray machine, a small needle will be guided towards the correct target
  • You will be injected with further local anaesthetic
  • The temperature of the tip of the needle will be raised using a highly sophisticated computer. Surrounding tissue will be heated using a radiofrequency generator.
  • If required, there will be multiple injections and neurotomies.

This procedure generally takes 30 – 45 minutes, with additional recovery time.

 

What are the potential complications?

As with every medical procedure, this is not without its complications. The procedure is very safe, but has risks including:

  • Discomfort at the site of the injection
  • A pain flare
  • Infection
  • Bruising
  • Weakness in muscles
  • Bleeding
  • Allergic reactions
  • Failure for the procedure to work to reduce pain
  • In 5% of cases, patients may experience temporary nerve damage. This can include feeling a burning sensation or numbness on a patch of skin. These symptoms can last several weeks.

There are also risks of more serious and rare side effects occurring. It is important to discuss these with your pain specialist, doctor or anaesthetist if you have any concerns.

 

What happens after the procedure?

  • You will be monitored for 60 to 90 minutes in a recovery area. Once this has been completed, you will be ready to go home.
  • Make sure you are accompanied home and have somebody stay overnight with you.
  • Any effects from sedation given during the procedure can last up to 24 hours. Do not be concerned if you cannot remember any information given to you during the procedure. This is a completely normal side effect of the medication.
  • The day of the procedure ensure you do not drink alcohol, drive a motor vehicle, operate heavy machinery, make important decisions, sign any legal documents or travel on your own.
  • When you wash the following day you will be able to remove the dressing.
  • The local anaesthetic will wear off, and may cause pain to return. In some instances, patients will feel increased pain and stiffness. This can often continue for several days and is called a pain flare. To alleviate pain, apply ice to the area for 10 minutes for the next 1 to 2 days. Pain killers can also aid with decreasing discomfort.
  • It is recommended to avoid rapidly completing physical activities right after your procedure. Instead, gently increase your daily activities.
  • If you notice any severe pain, swelling, discharge or bleeding from the site, please contact QPain, your General Practitioner, or your nearest Emergency Department.

 

Consent

Before undertaking any procedure, you will be asked to sign a form of consent. This will state that you completely understand and have been informed about the risks, benefits, alternatives and what will happen if you do not go ahead with the procedure.

As you must sign this form, it is important to ensure you are fully informed. If you have any underlying or unanswered questions, discuss these with your doctor.

Note that while you may sign the form of consent, you are able to change your mind at any time right up until the procedure begins.

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