Just like shoulders and knees, your back is connected by many joints, called facet joints. Facet joints connect your vertebrae to each other. Problems in these joints can cause chronic pain in the neck or back. They can also sometimes affect the shoulders,
arms, buttocks, or legs.
Medial branch nerves are the nerves that carry many of the pain messages from your facet joints.
Radiofrequency ablation of the medial branch is a type of medial branch neurotomy that is used to relieve arthritis pain. It uses radio waves to numb the nerves in your neck or back so that they can no longer send pain messages to your brain.
Before your doctor knows if a radiofrequency ablation will help you, they will do two medial branch blocks to find out if certain nerves are the ones that are a source of your pain. You will need three separate visits to have two medial branch blocks for diagnosis, and one radiofrequency ablation as the definitive treatment for your pain.
The doctor will use a tiny needle to numb the skin with lidocaine where you will get the block. Then they put the block needle into the numbed area. You may feel some pressure, but you should not feel pain. Using fluoroscopy (live X-ray) to guide the needle, we inject medicine onto one or more nerves to make them numb.
If you get relief from your pain in the next few hours, it’s a sign that those nerves may be contributing to your pain. The relief will last only a short time. We will do a short follow up visit to discuss whether you received adequate relief and decide on the next step. If you received significant relief, we will repeat the diagnostic block 2 weeks later. Please inform your physician how much pain relief you had from the procedure so that it can be documented and proceed with the radiofrequency ablation if indicated.
If you received significant relief from both blocks, you may then have a medial branch radiofrequency ablation at a later visit to try to get longer relief. The
radiofrequency ablation typically gives relief between 6 months to 1 year. It can then repeated as needed in the future for continued relief. It takes 10 to 20 minutes to get the medial branch block. You can usually go back home soon after the block. We will do a short follow up visit to discuss whether you received adequate relief and decide on the next step. You will need someone to drive you home.
The doctor will use a tiny needle to numb the skin where you will get the radiofrequency ablation. Then they would put the radiofrequency needle into the numbed area. You may feel some pressure. Using fluoroscopy (live X-ray) to guide the needle, the doctor sends electricity through the needle to the nerve for 60 to 90 seconds. The electricity heats the nerve, which silences it. The doctor may do this several times, and they may treat more than one nerve.
It takes 20 to 30 minutes to get a radiofrequency ablation, depending on how many nerves are ablated. You will need someone to drive you home.
You may feel a little sore or tender at the injection site at first. You may also feel sore at the ablation site for 1-2 weeks. However, after a successful radiofrequency ablation, most people have pain relief right away. It often lasts for 6 months or longer. Sometimes the pain relief is permanent.
If your pain does come back, it may mean that the damaged nerve has healed and can send pain messages again. Or it can mean that a different nerve is causing pain. Your doctor will discuss your options with you.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
Further reading: Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis
Figure 1: Just like you can get knee joint pain, the back joints are the most common cause for low back pain. These are small tiny joints called the facet joints (in red). These joints are sensed by small branches of nerves called the medial branch nerves (arrows). Treatment of these joint pain involves blocking (medial branch block) and eventually silencing these nerves (radiofrequency ablation) for prolonged relief. This is an effective non-surgical treatment, and it only involves flu-shot-sized needles (size of the needle is to scale).
Figure 2: Do you have chronic low back pain? Does your back hurt more when you rotate your torso to the left/right or bend to the back? If that’s the case, it’s likely from back joint arthritis, and the treatment is called lumbar medial branch block/radiofrequency ablation. This procedure targets the nerve (medial branch nerve)causing the pain from the arthritis. The lightning mark denotes the pain coming from the facet joint. Created with Visible Body 2021