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What is Radiofrequency Lesioning?
This is also called RF ablation, denervation, rhizotomy, etc. It is a technique
that destroys specific pain conducting nerves. By applying high frequency energy into nerve tissue via a needle, the
nerve tissue is destroyed. If the energy is applied continuously, the nerve heats up to above 65 degrees centigrade
which is enough to destroy conduction through that nerve (thermo coagulation RF).
If the energy is delivered as intermittent pulses, the tissue barely heats, yet conduction of signals along the nerve is interrupted anyway (pulsed RF). RF destroys the electrical conduction along nerves for 3-18 months. It appears to cause fewer side effects (painful dysesthesias) when used on unmyelinated
nerves such as those to the facet joints. It is also useful on discrete sensory cell bodies such as the dorsal root ganglia of the peripheral nerve roots and the trigeminal ganglion of the cranial nerves giving sensation to the face. In addition, sympathetic nerves are amenable to the RF procedure. These include the grey ramus
communicants RF for spine compression fracture pain treatment and splanchnic nerve RF for abdominal pain.
RF procedures such as facet RF denerve, are preceded by a diagnostic block to
ensure at least 50% reduction in pain on injection of a local anesthetic into the area. Usually, the diagnostic block and the therapeutic RF procedures are performed at two separate sessions to assure accuracy.
RF procedures, except pulse RF, are usually not performed on peripheral nerves due to worsening pain afterwards.
In those cases, it is better to use cryoneurolysis. Alternatives to RF include laser facet denervation.
Most spinal interventionists now recommend pulsed RF at 42 degrees centigrade for 120-180 seconds
Radiofrequency lesioning is a simple and safe treatment for Facet Joint
degeneration. It is performed as an outpatient procedure in an operating room
under fluoroscopic (x-ray) guidance and mild sedation. Using a specialized
machine, pain signals to the specific areas of the spine involving the nerves to
the facet joints are interrupted. Clinical data shows that this method is
effective in providing lasting pain relief. Patients are encouraged to resume
normal activities at their pace after the procedure.
What are the facet nerves?
Facet nerves are small nerves that branch out from larger spinal nerves exiting
the spine. These nerves contain mostly sensory information. The nerves supply
the facet joints, ligaments, skin, and small muscles at each segment. These are
NOT the nerves that are responsible for movement of the extremities and
sensation in the extremities.
Why do the facet joints become diseased?
The
reason is unclear. The facet joints have been shown to be load bearing and
stabilizing effect that prevents excessive rotation or forward slippage of the
vertebral bodies. Stresses on the facet joints can occur by sudden or repeated
lifting and twisting motions of the lower back or neck leading to irritation or
injury. A common condition known as degeneration of the discs may predispose the
facet joints to excessive stress and lead to arthritic changes. In the older
population, arthritic changes may cause pain and limitation of movement of the
affected spinal segment.
How is the procedure performed ?
Radiofrequency lesioning is performed in a fluoroscopic procedure room as an
outpatient setting. You will be lying on your stomach. Both local anesthesia and a mild
sedative may be used to minimize any discomfort during the procedure. Your
cooperation is necessary during the sensory and motor stimulation process to aid
in properly placing the lesioning electrode. Fluoroscopic control (x-ray
guidance) is used to help ensure safe and correct placement of the needle. Once
the needle is in the exact target area, a microelectrode is inserted through the
needle to begin the stimulation process. During this process, your physician
will ask you if you feel a tingling sensation. If there is stimulation down an
extremity, the needle is moved to a different location before lesioning. When
you feel stimulation locally and x-ray position is acceptable, lesioning is then
performed. A small amount of current will travel through the electrode into the
surrounding tissue and eliminate pain pathways. The procedure can take from
about twenty minutes to a couple of hours. After the procedure, you will need a
ride home. We advise patients to take it easy for a day or so after the
procedure.
Is
the procedure painful ?
You may feel some uncomfortable sensations at times during the testing phase.
You will receive sedation during the procedure and discomfort will be kept to a
minimum. Post procedure, you may experience some injection site tenderness for
several days. Ice packs the first day usually will control any discomfort. After
the first week is over, your pain may be decreased or gone completely.
Will
I have time off from work?
Radiofrequency treatments will not limit your daily activities. You should be
able to resume all your normal activities including work as soon as you feel
able.
Are there any risks or side effects from the procedure?
Any time there is an injection through the skin, there is a risk of infection.
This is why sterile conditions are used for these blocks. Because the procedure
is performed under x-ray control and patients are awake, the risk of large nerve
injury is very small. Nerve stimulation is performed prior to lesioning so that
large nerves that supply the extremities are not damaged.
Who should not have this procedure done?
If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have
an active infection going on, you should not have the procedure. If you have not
responded to local anesthetic blocks of the facets, you may not be a candidate
for this procedure
What
are the benefits of the radiofrequency lesioning?
Because the procedure disrupts nerve conduction (pain signals) it may in turn
reduce your pain and other related symptoms. Approximately 70-80% of patients
will get a good block of the intended nerve. Sometimes after a nerve is blocked,
it becomes clear that there is pain from the other areas as well.
Your physician will determine your response to the procedure. As with any other
procedure, the risks, benefits, and alternatives should be discussed. After the
procedure, your spinal specialist will guide you with further evaluations and
recommendations.
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