Radiofrequency ablation is a procedure using radio waves or electric current to generate sufficient heat to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months, although it may last as short as 3 months or as long at 18 months or longer.
Radiofrequency ablation is most commonly offered to patients with neck or back pain from facet joint problems like arthritis or injury. For these patients radiofrequency ablation is used to interrupt nerves that go directly to the individual facet joints. Radiofrequency ablation is also used in patients with RSD involving arms or legs to interrupt the sympathetic nerve supply to the involved arm or leg. Radiofrequency ablation can also be used for some unusual conditions, including pain from degenerative disks, occipital neuralgia and certain types of abdominal pain. You must have responded well to diagnostic or trial injections to be a candidate for radiofrequency ablation. Most patients who undergo radiofrequency ablation have typically tried other, more conservative, treatments such as anti-inflammatory medication, chiropractic or physical therapy.
Radiofrequency ablation disrupts nerve conduction, specifically interrupting the conduction of pain signals. In turn, this may reduce pain, and other related symptoms. Approximately 70 percent of patients will get a good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well.
Depending upon the areas to be treated, the procedure can take from twenty minutes to an hour.
Radiofrequency ablation is done in different positions depending on the nerves to be ablated. It is done either with the patient lying on the stomach when working on the facet joints, on the cervical or lumbar sympathetic nerves, and on spinal disks. It is performed occasionally on the back when ablation is in certain cervical or neck areas. The procedure is done under sterile conditions. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the procedure is carried out. The skin is numbed with a local anesthetic. Then X-ray or fluoroscopy is used to guide placement of the introducer needles. Since nerves cannot actually be seen on x-ray, the introducer needles are positioned using bony landmarks that indicate where the nerves usually are located. Thus, the X-ray is used to identify those bony landmarks. Once the introducer needle is in a good position by X-ray, a special electrically active needle tip is inserted. With this special needle tip in good position, electrical stimulation is done before any actual radiofrequency ablation. This electrical stimulation may produce a buzzing or tingling sensation or may feel like a deep ache or pain similar to the normal pain that you feel. Then a different type of electrical stimulation is used to make sure that no motor nerves are close by. When this type of stimulation occurs, you may feel some twitching or throbbing, but the physician is watching to make sure that no big muscle groups are being stimulated. You need to be awake enough during these parts of the procedure that you can report what you are feeling. If everything checks out okay, the tissue around the needle tip is numbed with local anesthetic. Then the tissues surrounding the special electrically active needle tip are then heated when electric current is passed through it. This effectively numbs or stuns the nerves semi-permanently. Once done, the needles are removed and a Band-Aid is applied.
Layers of muscle and soft tissues protect nerves. The procedure involves inserting an introducer needle or needles through skin and those layers of muscle and soft tissues, so there is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the introducer needle or needles.
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily with the physician during the procedure. However, some patients receive enough sedation that they have amnesia and cannot always remember parts or all of the actual procedure.
Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After that first several days, your pain may be gone or quite less.
You should have a ride home. You must have a ride home if you receive any sedation. We advise the patients to take it easy for a day or so after the procedure. You will be encouraged to apply ice to the affected area. Otherwise, you can perform any activities that you can reasonably tolerate.
You should be able to return to work the next day. For some patients, soreness at the injection site or sites may cause you to be off work for several days.
If successful, the effects of the radiofrequency ablation can last from 3-18 months, with a typical range of 6-9 months.
If the first procedure does not completely relieve your symptoms, you may be recommended to have a repeat or touch-up procedure after the first two to three weeks. Because these are not permanent procedures, they may need to be repeated when the effect wears off.
It is sometimes difficult to predict if the radiofrequency ablation will indeed help you or not. Generally speaking, the patients who have responded well to trial blocks will have better results than those who responded less well from diagnostic or trial injections.
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The risks and complications are dependent upon the sites that are ablated. Since the introducer needles have to go through skin and soft tissues, there will usually be some soreness and occasionally bruising. The nerves to be ablated may be near blood vessels or other nerves that can be potentially damaged. Electricity is also used during the procedure raising the possibility of an electrical burn. Great care is taken when placing the radiofrequency needles and using the electrical current, but sometimes complications occur. Fortunately, serious complications or side effects are uncommon.
Patients on a blood thinning medication, patients with an active infection going on, or patients with poorly controlled diabetes or heart disease should not have the procedure or at least consider postponing it if postponing would improve your overall medical condition. Of course, patients who have not responded to trial blocks or diagnostic injections would be unlikely to benefit from radiofrequency ablation.
Adapted: http://www.medcentral.org/body.cfm?id=352, July 25th, 2010