What is a Cervical Radiofrequency Ablation?
Radiofrequency Ablation (RFA) is a trusted and highly effective treatment for pain relief used by the experts at Wake Spine & Pain Specialists. With RFA, a heated needle tip is used to disrupt nerve conduction, which prevents transmission of pain signals and reduces discomfort in a painful area. RFA can be used in a variety of pain syndromes, especially in those that involve back pain and neck pain.
The chief advantages of Radiofrequency Ablation include its ability to precisely target an area of pain as well as its high efficacy as a pain treatment modality. Also, RFA is regarded as a safe therapy with few reported complications, mainly because the doctor can stimulate a specific area before initiating ablation, which precludes ablating the wrong nerves.
Indications of Radiofrequency Ablation
The bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. The vertebrae interact, or articulate, smoothly with each other at joints located between and behind the vertebrae. Called facet joints, these structures stabilize the spine, preventing excessive motion in all directions. Degeneration and arthritis of the bones can lead to painful friction between facet joints and compression of nerves that exit the vertebral column.
Medial branch nerves are small nerve branches that communicate pain caused by the facet joints in the spine to the brain. They are located at the junction of the transverse process and superior articular process of the facet joint. Medial branch RFA is a minimally invasive outpatient procedure that reduces cervical (neck), thoracic (mid-back), and lumbar (low back) pain by interrupting the nerve supply from painful facet joints (Murtagh & Foerster, 2006). According to the American Society of Interventional Pain Physicians, multiple RFA injections for medial branch blocks provide long-term pain relief, and the evidence for pain relief with radiofrequency neurotomy of cervical and lumbar medial branch nerves is moderate for short and long-term pain relief (Boswell et al, 2007).
Another common site treated with Radiofrequency Ablation is the sphenopalatine ganglion, a bundle of nerves that provides innervation to the face and head. Frequently, face pain and headaches can be treated successfully with sphenopalatine ganglion blockade or RFA. For example, a recent article showed that the sphenopalatine ganglion can be targeted with RFA for treatment of chronic headaches and other conditions causing atypical facial pain (Bayer, 2005).
Beyond spinal joint pain, face pain and headaches, other conditions that your doctor may treat with Radiofrequency Ablation include:
- Certain Peripheral Neuropathies
- Peripheral Nerves (occipital, saphenous, lateral femoral cutaneous…)
- Spinal Nerves
- Sympathetically Mediated Pain
- Complex Regional Pain Syndrome (CRPS)
- Reflex Sympathetic Dystrophy (RSD)
- Trigeminal Neuralgia
- IDET (a type of intra-discal RFA)
- Disc Denervation
Radiofrequency Ablation Procedure Description
Radiofrequency Ablation is an outpatient procedure that creates a nerve lesion by application of localized heat. When the lesion is placed over a painful nerve, pain signals are interrupted and pain perception by the brain is decreased.
Radiofrequency Ablation treatment is performed with local anesthesia, along with IV sedation when needed. The injection site is numbed and a needle is directed through the tissue toward the affected nerve using fluoroscopic (X-ray) guidance. When the needle is in the correct location, an electrode is introduced into the center of the needle. Stimulation is initiated first with sensory stimulation and then with motor stimulation. When the correct needle position is verified, local anesthetic and a steroid medication may be injected. Afterward, there is a brief recovery period before the patient is released home. You may have some discomfort when the local anesthetic wears off. If your pain responds well to an initial treatment, a follow-up treatment may be helpful.
Two less aggressive variations of RFA are radiofrequency thermo-coagulation and pulsed-RFA. In radiofrequency thermo-coagulation, the electrode is heated to 50-90°C and kept at that temperature for around a minute, allowing the electro-thermal heat to destroy surrounding pain fibers. And in pulsed-RFA, a lower level of heat is applied to the affected area. Pulsed-RFA does not destroy the nerve tissue, but instead stuns the nerve. This method is less uncomfortable and in general only a mild pulsating sensation is felt. Unfortunately, pulsed-RFA is often not covered by health insurance companies.
Benefits of Radiofrequency Ablation
Since the first Radiofrequency Ablation description in early 1990s for percutaneous tumor ablation, a considerable amount of data on the subject has been published (Hong & Georgiades, 2010). The technique continues to progress, with greater efficacy and fewer risks. Since the procedure is minimally invasive yet highly effective, patients can experience significant pain relief without hospitalization.
One strong study by Bayer et al (2005) found 21% of patients in the study had complete pain relief, and 65% reported mild to moderate pain relief. Further, the majority of the respondents reported reduction in the use of pain medications, and none of the patients developed significant infection, bleeding, hematoma formation, or numbness as complications to their therapy. Another study demonstrated the general success of RFA included a 2010 meta-analysis, that found RFA effective in the management of sacroiliac joint pain at 3 and 6 months after treatment (Aydin et al, 2010).
According to a review, RFA for cervical and lumbar level has produced the most solid evidence of efficacy (Van Boxem et al, 2008). For example, one recent study on RFA for lumbar facet joint nerve pain in soldiers on active duty found RFA of lumbar facet joint nerves was so effective that medical evacuation from Iraq was prevented and all soldiers were able to return to rigorous combat duties (Dragovich, 2011). And a placebo-controlled study in 40 patients with chronic low back pain from facet joints found the active treatment group showed statistically significant improvement not only in back and leg pain, but also back and hip movement and the sacro-iliac joint test (Nath et al, 2008). There was significant improvement in quality of life variables, global perception of improvement, and generalized pain, with improvement in the active group significantly greater than that seen in the placebo group with regard to all the above-mentioned variables. None of the patients enrolled in the study had any complication other than transient postoperative pain that was easily managed.
There is strong clinical evidence that RFA has an important role in the management of trigeminal neuralgia and spinal pain (Lord & Bogduk, 2002). Regarding trigeminal neuralgia, 92.5% of subjects in a large study achieved excellent or good pain-relief by radiofrequency thermo-coagulation (Chen et al, 2001). Further, 100 patients trigeminal neuralgia who were treated by radiofrequency thermo-coagulation showed such improvement that the researchers concluded RFA is the treatment of choice for trigeminal neuralgia when medical treatment is no longer effective or the side-effects of medications contraindicate their usage (Motta et al, 1980). A study that evaluated 39 patients with trigeminal neuralgia discovered 92.3% received satisfactory pain relief (Sengupta & Stunden, 1977).
With regard to RFA for spinal pain, a related study found 28 patients who received pulsed-RFA for neuropathic spinal pain found 19 of these patients (68%) reported long-term pain relief, which was defined as more than 1 year (Shabat et al, 2006). The only complication reported was mild discomfort in the treated area, which spontaneously resolved within 3 weeks after the procedure.
Another successful application for RFA therapy may be in the management of occipital neuralgia. Patients who received RFA for the condition found 43 (88%) achieved a successful outcome, and the median duration of relief in these patients was 297 days, with eight patients continuing to have ongoing relief (Govind et al, 2003). A prospective trial with 6 months of follow-up, in which pulsed-RFA was used to treat the greater and/or lesser occipital nerve, found mean scores on pain scales declined in 19 patients over 6 months, and no complications were reported (Vanelderen et al, 2010).
RFA has proven to be a versatile treatment modality with rarer but similarly efficacious applications. Beyond typical spinal and cranial neuralgias, RFA has been used successfully in the treatment of neurogenic heel pain (Cozzarelli et al, 2010), sacroiliac joint pain, certain types of cancer pain (Patti et al, 2002; and Raslan, 2008), orchialgia (Cohen & Foster, 2003), pudendal neuralgia (Rhame et al, 2009), and hip joint pain (Wu & Groner, 2007). Hypothetically, as RFA becomes a more widely practiced therapy, even more applications will be reported in medical literature.
Radiofrequency Ablation Risks
Any medical procedure carries a variable risk of complications. In general, the risks of Radiofrequency Ablation are low and complications are rare. Infrequently, side effects such as bleeding, infection, worsening of pain symptoms, discomfort at the point of injection, and motor nerve damage may occur following an RFA procedure. “Neuritis” or irritation of a nerve after a radiofrequency procedure is a fairly common side-effect of radiofrequency, but is rarely problematic for most people. It seems to be more common for cervical (neck) procedures and slightly more common in women than men. This irritation usually resolves within two months.
Radiofrequency Ablation treatment is an extremely safe, well-tolerated method selected to treat many causes of chronic pain (Chua et al, 2010). Often, the nerve regenerates following RFA, causing the pain to return. Pain relief lasts until the nerve regrows. Typically, this period is 3 to 12 months; however, in some cases, pain relief lasts for years.
Wake Spine & Pain Specialists understands the stress and inconvenience of living with a painful condition and we are excited to offer this advanced treatment. Call today to schedule a consultation for your back pain, neck pain, mid-back pain, facial pain, or other painful conditions.