Lumbar Medial Branch Radiofrequency Ablation
Radiofrequency ablation (RFA) is a procedure to reduce the ability of nerves to transmit pain. When we use this technique around the lumbar spine, it can be incredibly effective at reducing lower back pain due to a variety of conditions.
The procedure is often used in conjunction with a medial branch block (MBB) to identify the exact source of pain. The ablation then occurs when a specialized needle is placed at the irritated nerves and heated to about 80o C. This destroys the nerves, permitting them from passing pain signals along to the brain.
Would lumbar RFA be helpful for me?
A lumbar radiofrequency ablation is most commonly performed to treat arthritis-related pain in the lower back, but the procedure may be helpful in other conditions as well:
Prior Back Surgery
Neuropathic pain conditions (e.g. complex regional pain syndrome)
Lumbar spondylolisthesis or shifting of the spine
Whiplash Syndrome
Spinal arthritis due to lumbar spondylosis, degenerative changes in the spine
Bertolotti’s Syndrome, fusion of L5 spinous process with Sacrum
It turns out we can also apply the RFA technique to other nerves in the body, treating a host of chronic pain conditions. These include arthritis of the neck, headaches, trigeminal neuralgia, osteoarthritis of the knee, scapular pain, peripheral neuropathies, and sympathetic nerve pain. Your doctor will help walk you through the process of deciding if RFA is appropriate for you.
How would lumbar RFA benefit me?
A 2007 clinical study on patients treated with RFA therapy indicated that 68.4% of patients had good to excellent relief from chronic back pain. It is common for the pain relief from an RFA to last 6 to 12 months, and in some cases may last for a few years. This can be especially helpful for patients who wish to reduce the amount of medicine they take in the long run.
Radiofrequency ablation is an extremely safe and well-tolerated method of relieving pain. Some patients may have initial concerns over burning the nerves in their back. But RFA is a targeted therapy, meaning it only destroys the nerves that send pain signals to the brain. The nerves returning from the brain that control motor function to the back are left untouched and fully functioning.
For patients who suffer the effects of arthritic back pain on a daily basis, RFA treatment can be an excellent way to ease pain, increase mobility, and reduce the use of analgesic medication.
What can I expect if I undergo lumbar RFA?
The nerves commonly contributing to arthritic pain in the low back run across the bones of the spine, and are referred to as medial branch nerves. Before we ablate them, we confirm that these nerves are, indeed, the source of the pain you experience.
This is done by means of a medial branch block (MBB), a simple injection of lidocaine that numbs the nerves and serves as a diagnostic tool. This can be performed under light anesthesia to ensure your comfort during the procedure.
The lidocaine may only be effective for several hours, but this is all we need to diagnose the source of the pain. If the patient feels a significant sense of relief, we’ve now confirmed which nerves should be targeted by the longer-lasting RFA.
The ablation, itself, is an outpatient procedure that takes no more than an hour to complete. Your doctor uses a local numbing medicine in your back, but can also administer a mild IV anesthetic to keep you calm and relaxed during the treatment. Once comfortable, live X-ray imaging will guide the doctor as he places a specialized needle through the skin and next to the targeted nerve.
An electrode is then inserted through the needle and comes to rest against the nerve. A final numbing agent is applied before the heat-generating current is delivered. Typically about 80o C, the current is delivered to the site for 2-4 minutes.
When the procedure is over, you’ll want to take the rest of the day to rest and recover. You may experience some soreness at the injection site immediately after the procedure, but as this subsides, you should begin to experience the targeted relief from your chronic pain.
At Cahaba Pain and Spine Care, we are committed to reducing your pain and improving your overall quality of life. If you think you might be a candidate for lumbar RFA, we’d be pleased to schedule a consultation to discuss the treatment options together.