Radiofrequency Ablation (Facet Ablation)

Radiofrequency ablation (RFA), also called facet ablation or rhizotomy, uses gentle heat to quiet the small nerves that carry pain signals from arthritic joints in the spine. A special needle is placed next to the nerve, and radiofrequency energy heats the tip to create a small area that stops the nerve from sending pain signals.

RFA is used most often for the facet joints of the neck and lower back, and it can also be used for the sacroiliac (SI) joint.

These injections are usually performed by a pain management specialist or interventional physician. Dr. Grunch works closely with trusted pain management specialists and will refer you when an injection is a good next step, either to treat your pain or to help confirm where it is coming from.

• People with chronic back or neck pain from the facet joints who had good, short-term relief from a medial branch block
• People with spinal arthritis
• Some people with SI joint pain

RFA does not fix a pinched nerve or herniated disc; it is for joint-related pain that stays mostly in the back or neck.

• Ask about blood thinners. If you take a blood thinner such as warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), clopidogrel (Plavix) or daily aspirin, tell the doctor doing the injection. Some injections require stopping it for a few days and some do not. Never stop a blood thinner on your own; the doctor who prescribes it will tell you if and when it is safe.
• If you have diabetes and a steroid will be used, check your blood sugar more often for a few days afterward.
• Tell the team about any allergies, especially to contrast dye, iodine, latex or numbing medicine.
• Reschedule if you have a fever or an infection, or if you might be pregnant.
• Arrange for a driver if you will be given medicine to relax.

You will lie face down and may get medicine to relax. The skin is numbed, and X-ray is used to guide a thin needle next to each target nerve. Before treating, the doctor may send a tiny electrical signal to make sure the needle is in the right place and away from important nerves. You may feel tingling or pressure. Then the nerve is numbed and heated for about a minute or two. Treating several levels usually takes 30 to 60 minutes.

Soreness, a sunburn-like feeling or muscle spasms in the area are common for 1 to 2 weeks. Ice and over-the-counter pain medicine help. Pain relief usually begins within 2 to 4 weeks and often lasts 6 to 12 months or longer. The nerves slowly grow back, so the procedure can be repeated if pain returns. This is a great window to build strength with physical therapy.

RFA is generally safe. Possible side effects include temporary soreness, numbness or burning skin sensation, and rarely infection, bleeding or nerve injury. Tell the team if you have a pacemaker, spinal cord stimulator or other electrical device.

How long does radiofrequency ablation last?

Relief often lasts 6 to 12 months and sometimes longer. Because the nerves can regrow, the procedure can be repeated if pain returns.

Is facet ablation painful?

The skin is numbed and many people receive medicine to relax. Soreness for 1 to 2 weeks afterward is common.

Why do I need a medial branch block first?

The block shows whether the facet joints are truly the source of pain. Ablation works best for people who had good relief from the block.

If you have neck pain, back pain or nerve pain and want to know which treatments make sense for you, call 470-293-9800 or contact us to schedule a visit with Dr. Grunch or one of her physician assistants. You can also ask general questions any time through our “Ask Us Anything” chat.

Related: All non-surgical treatment options · Medial branch block · Facet joint disease

This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms and treatment options.