September 16, 2020  | By

By: Dr. Tanuj Palvia, MD

You’ve tried medications.

You’ve tried physical therapy.

You’ve tried steroid injections.

It is frustrating.

When nothing works for the chronic pain of osteoarthritis, it can leave you feeling defeated.

But there is possible hope in a procedure for treating certain kinds of osteoarthritis, including the spine and knee, known as Radiofrequency Ablation (RFA).

What are the facet joints?

Facet joints connect the vertebrae, which are the bones of the spine. These joints, about the size of a thumbnail, are found on both sides of the spine. The facet is where the pivoting of these vertebrae occurs.

Pain from these joints can also occur due to an injury. This pain can feel like muscle tension or stiffness; sometimes it can be much more severe. The cartilage or the ligaments supporting the joints can become injured. This can result in degenerative damage leading to arthritis and associated problems, including inflammation and pain.

Different joints can lead to different areas of pain; for example, lumbar facet joint pain can occur in an area beginning in the low back and radiate into the buttocks, groin, or hips.

If you have pain in one or more of these areas lasting longer than 6 weeks, you may be dealing with lumbar facet pain. This can sometimes, but not always, be diagnosed via x-ray or MRI. A more definitive diagnosis can be made by performing a medial branch nerve block, which is a diagnostic test involving anesthetizing the nerve supplying these joints, temporarily alleviating the pain generator in question.

What is Lumbar Radiofrequency Ablation?

A lumbar facet/medial branch nerve radiofrequency ablation (RFA) is an outpatient procedure for treating osteoarthritic pain that emanates from the neck, mid-back, low back, hips, or knees. Other names used for this procedure are lumbar facet thermal coagulation or rhizotomy.

RFA uses radiofrequency energy to disrupt nerve function. When this is done to the medial branch nerve, which is a nerve that supplies sensation to the facet joint, the nerve can no longer transmit pain from the injured facet joint. This nerve has no innervation to your extremities, thereby making it very safe.

This similar concept applies to other areas, including facet joints in the neck or midback. It can also be performed in sensory nerves of the knee, known as genicular nerves.

What happens during the procedure?

I usually like to administer a light amount of intravenous sedation during the procedure to reduce anxiety and any pain associated with the procedure. Once I have you positioned, I apply a copious amount of local anesthetic to numb the pertinent areas of the skin.

Subsequently, I insert a small needle near the facet joint where the medial branch nerve is located. This is confirmed with fluoroscopy, a type of live x-ray. Once in place, I perform nerve stimulation to test the accuracy of needle placement, which oftentimes causes some painless muscle twitching which can be perceived by the patient as pressure.

After the confirmation, I apply local anesthetic near this nerve to remove all sensation. I then use a radiofrequency generator to transmit a small current of RF energy through an insulated electrode placed at the nerve ablation site. The purpose of this ablation is to deactivate the nerves responsible for sending pain signals to the brain.

I often repeat this at more than one facet joint to cover all of the affected areas. The entire procedure takes about 15 minutes and can be performed in my office.

What happens after an RFA?

After the procedure, you are monitored for about half an hour. Upon discharge, you will receive instruction by staff. Generally, there is soreness after the procedure for 3-7 days, however, for those patients with a more chronic presentation may experience stiffness beyond this time frame as the muscles adjust to a more mobile state as the pain generator has been extinguished. There may be some numbness, weakness, or itchiness for a couple of weeks. Maximum pain relief occurs in 2-3 weeks, but may take as long as 6-8 weeks to be realized.

How long can I expect pain relief?

The medial branch nerves will regenerate after a radiofrequency ablation, but the length of time is variable. The average time is 6 months, and during this time, proper rehabilitation to improve functionality is imperative. This way, once the nerves regrow-, the pain will be less or even no longer there. If there is, a subsequent RFA procedure can be performed.

If you’d like to learn more about Radiofrequency Ablation or schedule an appointment, give us a call or you can start by filling out the form below.


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