RADIO FREQUENCY LESIONING
"PERMANENT ANESTHETIC BLOCK OF SPINAL FACET JOINTS"
(RADIO FREQUENCY LESIONING, JOINT DENERVATION, THERMOCOAGULATION OF FACET NERVES)
What is this procedure?
.This is a minimally invasive technique for relieving neck and back pain. It uses is a specialized machine called a “radiofrequency lesion generator” to block pain signals coming from painful joints or fractures in the spine.
Who is a candidate for this procedure?
Currently, Radio Frequency Lesioning is offered to patients with:
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.
How long does pain relief usually last after the procedure?
Pain relief is often permanent. Sometimes pain returns in 6-12 months, and when this happens the procedure is repeated, usually with good results again.
What are my chances of having pain relief; and does this procedure ever not work?
A decrease in pain by at least 50% happens about 75% of the time. The procedure does not help at all sometimes, and this is probably because the nerves are too hard to block.
Can the procedure make me worse?
There is no reason for the procedure to make back pain worse, it does not change the spine. Patients occasionally have new numbness and sometimes burning pain near the treatment site that last up to a few months, but this is temporary. In our experience, an occasional patient reports worsening of their pain after the procedure but this is uncommon and it is not possible to say whether it is the procedure or simply the natural progression of their back pain causing the pain increase.
How long does the procedure take?
Depending upon the areas to be treated the procedure can take from about 20 minutes to 45 minutes.
Where is the procedure performed?
The procedure is usually performed in an operating room or sometimes in a fluoroscopy (x-ray) room.
How is the procedure performed?
The goal for the procedure is to heat the tiny nerve branches that supply the painful facet joints or stress fracture enough so that they do not work. This amounts to “cutting” the nerves to the joints, although only heat is used. Needles are positioned close to the target nerves and a small electrical current from the radiofrequency lesion generator is passed through the needle to heat the target nerves. The doctor controls the amount of heat very precisely, using the radiofrequency lesion generator machine. The nerves are heated for about 1 minute. The needles are then withdrawn and the procedure is over.
You will be lying on your stomach. 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 close to the small nerve branches that go to the painful joints.
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, and you will receive a small amount of x-ray during the procedure as the doctors positions the needles (less than a chest x-ray dose). A small test current is passed through the needle to be sure it is close to the target nerve. You will feel a twitch of the back muscles when this is done, this is not painful. A local anesthetic is injected to confirm proper placement.
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. It is necessary for you to be awake enough to communicate easily during the procedure.
What to 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, are there any restrictions?
You should have a ride home. We advise you to take it easy for a day or so after the procedure. It is a good idea to take the day after the procedure off from work. You may want to apply ice to the affected area. Perform normal activities as you can tolerate them, use pain as your guide as you would always, there are no special restrictions, and the procedure does not increase the chances that you will hurt yourself you’re your usual activity.
Can I go to work the next day?
It is a good idea to take the day after the procedure off from work.
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 for up to one week. 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 complications could occur, although they are extremely rare. These include damage to major nerves that would cause pain, numbness or weakness. This is very, very uncommon, so uncommon that there are no statistics on this risk. Please discuss any specific concerns with your physician.
| 1. | Patients with 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. Please see the patient education pamphlet on facet blocks for details on that testing procedure). | |
| What is facet pain usually like? | ||
| • | Back pain from facet joints is usually worst with standing. Sometimes, patients with spinal stenosis have back pain in addition to their leg pain, and the back pain may be from painful joints. If so, this procedure may help. Facet pain does not cause pain to radiate down the leg past the knee, this is caused by a different spine problem. | |
| • | Neck pain from facet joints is often worse on one side that the other and bad with turning the head to look over the shoulder. Facet pain is a common cause of persistent pain after a whiplash injury. Patients with neck pain usually do not have pain radiating all the way down the arm to the forearm or hand. | |
| 2. | Patients with painful “stress fractures” of the lumbar spine, also called spondylolysis. The procedure makes these numb, as well as the adjacent joints. |
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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.
How long does pain relief usually last after the procedure?
Pain relief is often permanent. Sometimes pain returns in 6-12 months, and when this happens the procedure is repeated, usually with good results again.
What are my chances of having pain relief; and does this procedure ever not work?
A decrease in pain by at least 50% happens about 75% of the time. The procedure does not help at all sometimes, and this is probably because the nerves are too hard to block.
Can the procedure make me worse?
There is no reason for the procedure to make back pain worse, it does not change the spine. Patients occasionally have new numbness and sometimes burning pain near the treatment site that last up to a few months, but this is temporary. In our experience, an occasional patient reports worsening of their pain after the procedure but this is uncommon and it is not possible to say whether it is the procedure or simply the natural progression of their back pain causing the pain increase.
How long does the procedure take?
Depending upon the areas to be treated the procedure can take from about 20 minutes to 45 minutes.
Where is the procedure performed?
The procedure is usually performed in an operating room or sometimes in a fluoroscopy (x-ray) room.
How is the procedure performed?
The goal for the procedure is to heat the tiny nerve branches that supply the painful facet joints or stress fracture enough so that they do not work. This amounts to “cutting” the nerves to the joints, although only heat is used. Needles are positioned close to the target nerves and a small electrical current from the radiofrequency lesion generator is passed through the needle to heat the target nerves. The doctor controls the amount of heat very precisely, using the radiofrequency lesion generator machine. The nerves are heated for about 1 minute. The needles are then withdrawn and the procedure is over.
You will be lying on your stomach. 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 close to the small nerve branches that go to the painful joints.
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, and you will receive a small amount of x-ray during the procedure as the doctors positions the needles (less than a chest x-ray dose). A small test current is passed through the needle to be sure it is close to the target nerve. You will feel a twitch of the back muscles when this is done, this is not painful. A local anesthetic is injected to confirm proper placement.
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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. It is necessary for you to be awake enough to communicate easily during the procedure.
What to 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, are there any restrictions?
You should have a ride home. We advise you to take it easy for a day or so after the procedure. It is a good idea to take the day after the procedure off from work. You may want to apply ice to the affected area. Perform normal activities as you can tolerate them, use pain as your guide as you would always, there are no special restrictions, and the procedure does not increase the chances that you will hurt yourself you’re your usual activity.
Can I go to work the next day?
It is a good idea to take the day after the procedure off from work.
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 for up to one week. 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 complications could occur, although they are extremely rare. These include damage to major nerves that would cause pain, numbness or weakness. This is very, very uncommon, so uncommon that there are no statistics on this risk. Please discuss any specific concerns with your physician.
