Treating Lumbar Facet Joint Pain With Radiofrequency Ablation (Radiofrequency Neurotomy)

Of the millions of chronic back pain sufferers in America, just less than half (45%) have the facet joints as their pain generator. This is termed facet joint syndrome. Facet joint injections are the most common interventional pain management procedure by far in the US. They work well about 80% of the time.

Making the diagnosis of facet joint syndrome is difficult with simply a history, physical examination, and imaging studies. Similar to arthritis seen in other body joints like the knee and hip, the presence of arthritis does not mean the patient will have pain. Endstage degenerative arthritis may be present with the patient experiencing minimal pain.

The best method available for determining whether or not a patient has facet joint syndrome is a diagnostic injection into the joint. This injection is when a pain doctor performs a diagnostic injection of numbing medicine around the facet joint to numb up the small nerve endings supplying sensation to the joint (and pain). If the patient's pain is substantially relieved from the numbing injection, then the diagnosis of facet joint syndrome is cemented.

Facet joint intra-articular injections and medial branch blocks have been shown to provide on average five to seven months of pain relief. When the pain wears off, the injections can be repeated with similarly successful results.

In the 1970's and 80's, radiofrequency denervation was developed for the first time and modified as it became more successful. It has grown in popularity as clinical research studies have shown very good outcomes with the procedure.

Radiofrequency ablation involves putting a catheter in the same area as where a medial branch block is performed. Rather than injecting the numbing medicine at that point, the tip of the catheter is heated with radiofrequency waves and the tiny little nerve endings are deadened.

Results of studies that have been done looking at radiofrequency neurotomy have been encouraging. Good to excellent results after RF procedures have been 70-90% for a year with pain being relieved for up to 2 years. This is much longer than facet joint injections. Eventually the medial branches that were deadened will regenerate and the pain may return. At that point the procedure may successfully be repeated. The RF procedure may allow patients to decrease their pain medication needs substantially.

It should be noted that patients may temporarily see increased pain after a radiofrequency ablation. This may be due to muscle spasms from the procedure. Typically within a week the pain relief will begin and the benefits will be noticed.

RF procedures are performed in an outpatient setting. They can be done under local numbing and/or IV sedation. The procedure is predominantly safe with a low risk profile, but there are potential complications. Those include dural puncture, spinal cord trauma, infection, painful dysethesias/hyperesthesia, or increased pain.