What is Radio Frequency Lesioning?

Radio Frequency Lesioning is a procedure using a specialized machine to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months (can be as short as 3 months or permanent).

Am I a candidate for Radio Frequency Lesioning?

Currently, Radio Frequency Lesioning is offered to patients with:

• RSD/CRPS/SMP involving upper and lower extremities
• Neck or back pain due to facet joint disease (The source of pain has to be proven to be these joints with test blocks--either facet injections or facet nerve block)
• Occipital neuralgia
• Abdominal (visceral) pain responsive to splanchic nerve blocks.
You must have responded well to local anesthetic blocks to be a candidate for Radio Frequency Lesioning.
• Nerve root pain

What are the benefits of Radio Frequency Lesioning?

The procedure disrupts nerve conduction (such as conduction of pain signals) and it may in turn reduce pain and other related symptoms. Approximately 70-80% of patients will get 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 area as well

How long does the procedure take?

Depending upon the areas to be treated the procedure can take from about twenty minutes to a couple of hours.

Where is the procedure performed?

The procedure is usually performed in an operating room or sometimes in a fluoroscopy (x-ray) room.

How is it actually performed?

Since nerves cannot be seen on x-ray, the needles are positioned using bone landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A local anesthetic is injected to confirm proper placement. After confirmation of the needle tip position, a special needle tip is inserted. When
the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing or tingling sensation or may be like hitting your "funny bone". You may also feel your muscles jump. You need to be awake during this part of the procedure so you can report what you’re feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Ra-dio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently to permanently.

Will the procedure hurt?

Layers of muscle and soft tissues protect nerves. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues so there is some discomfort involved. However we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Rarely patients receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon your tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.

How is the procedure performed?

You will be lying on your stomach when working on the lower cervical and lumbar facet joints, or lumbar sympathetic nerves. You will be lying on your back when lesioning the upper cervical (neck) area (e.g. Stellate Ganglion). You are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Depending
on which area the procedure is taking place the skin is cleansed with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles.

What should I expect after the procedure?

Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After the first week is over your pain may be gone or considerably less.

What should I do after the procedure?

You should have a ride home. We advise you to take it easy for a day or so after the procedure. You may want
to apply ice to the affected area. Perform normal activities as you can tolerate them.

Can I go to work the next day?

You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.

How long will the effects of the procedure last?

If successful the effects of the procedure can last from 3 months to permanent but usually 6-12 months.

Will my skin stay numb afterwards?

No, not unless you have a very rare complication where too many nerves are lesioned (blocked).

How many procedures do I need to have?

If the first procedure does not relieve your symptoms completely you may be recommended to have a repeat procedure after re-evaluation. Because these are sometimes not permanent procedures, they may need to be repeated when the pain relief wears off (often 6-12 months).

Will the Radio Frequency Lesioning help me?

It is very difficult to predict if the procedure will indeed help you or not. Generally speaking the patients who have responded to repeat local anesthetic blocks will have better results.

What are the risks and side effects?

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 lesioned. Anytime there is an injection through the skin; there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves
to be lesioned may be near block vessels or other nerves which can be potentially damaged. Great care is taken when placing the radio frequency needles but sometimes complications occur. Please discuss your specific concerns with your physician. Rarely, nerves near the target nerves can be accidentally injured causing pain, numbness, or weakness. This is very, very uncommon. If you are having a radio frequency sympathectomy,
your hand or foot may feel warmer than you would like, or too dry (from decreased sweating).

Who should not have this injection?

If you are on a blood thinning medication (e.g. Coumadin®, Heparin, Plavix®), or you are or could be pregnant, have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks you may not be a candidate for this procedure.

5/06/02