Lumbar Radiofrequency Ablation

Lumbar Radiofrequency Ablation - for Chronic Low Back Pain

A lumbar radiofrequency ablation (RFA) is an outpatient procedure for treating low back, buttock, hip, and groin pain. It is also called lumbar facet thermal coagulation or rhizotomy.

This information will explain what it is, Dr. Singer can determine if it is for you.

What are lumbar facet joints? Facet joints are paired structures at the back of each vertebra (spinal column bones). The facet joints, like other joints in the body, form a working motion unit that allows movement between two vertebrae. Facet joints connect the vertebrae, the bones of the spine. The low back area of the spine is called the lumbar region. It contains five vertebrae. Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Lumbar facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right L4-5 facet joint, for example, joins the 4th and 5th lumbar vertebrae on the right side. Medial branch nerves are found near facet joints. They transmit pain signals from the facet joints to your brain.

What is lumbar facet joint pain? You may feel pain if a lumbar facet joint is injured. Sometimes it feels like muscle tension. Other times it can be a severe pain. The cartilage inside the joint may be injured. Other times only connecting ligaments surrounding the joint are injured. Facet pain also depends on which facet joints are affected. Pain from lumbar facet joints occurs in an area from your low back down to your buttocks, groin, and hips.

How do I know if I have lumbar facet pain? When a facet joint is injured, pain signals from the facet joints travel along sensory nerves called the medial branches to the spinal cord and then to the brain. The injury may involve the cartilage (slippery covering of the ends of bones), the capsule, or the ligaments that surround the joint and connect it to the other parts of the spine. Additionally, the joint injury or pain may also cause muscle spasms. The location of the pain depends upon which facet joint has been injured. Lumbar facet joint injuries can cause pain in your lower back to your buttocks. Before a lumbar radiofrequency ablation (lumbar RFA) is considered, Dr. Singer will perform a clinical exam and a diagnostic procedure (lumbar medial branch block) to temporarily block the medial branch nerve to identify the source of pain.

What is a lumbar RFA? A lumbar RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the medial branch nerve.

What happens during an RFA? After changing into a hospital gown, you will be taken to the procedure room in a wheelchair. You will lay on your stomach on the procedure table during the injections. If needed, sedative medication may be given to reduce discomfort. You will be awake during much of the procedure. A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle near the facet joint. Fluoroscopy, a type of x-ray, must be used to position the needle. The doctor will then check to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching and provoke some of your pain. Once the needle is properly placed, the nerve will be numbed. Radiofrequency energy will then be used to disrupt the medial branch nerve. This is often repeated at more than one level of the spine.

What happens after an injection? You will be free to get re-dressed and check out at the front desk. It may help to move in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. Take it easy for the rest of the day. You may feel sore for one to four days. It may be due to muscle and nerve irritation. Your back may feel numb, weak, or itchy for a couple of weeks. Maximum pain relief may take two to three weeks.

How long can I expect pain relief? Nerves regenerate after an RFA, but how long this takes varies. Your pain may or may not return when the nerves regenerate. If it does, another RFA can be done.

This information is for general education only. Specific questions or concerns should always be directed to your doctor. Your doctor can explain possible risks or side effects.