What is a Lumbar Radiofrequency Neurotomy? A Comprehensive Guide

Radiofrequency ablation (RFA), also called Radiofrequency Neurotomy, is a medical procedure that uses high-frequency electrical energy to create heat and destroy any abnormal tissue. It is often used to treat certain types of medical conditions that cause chronic pain or dysfunction, such as tumors, varicose veins, and certain types of cardiac arrhythmia.

young woman in bed experiencing neck and back pain

Why is radiofrequency ablation (RFA) done?  

Radiofrequency ablation (RFA) may be performed to treat a wide variety of medical conditions that cause chronic pain or dysfunction. Some of the most common reasons for performing RFA include: 

  • Pain relief: RFA can be used to relieve chronic pain in the back, neck, knee, hip, shoulder, and other areas of the body. It is often used to treat conditions such as arthritis, chronic headaches, and nerve pain. 
  • Tumor treatment: RFA can be used to treat certain types of tumors, including liver tumors, lung tumors, and bone tumors. 
  • Varicose vein treatment: RFA can be used to treat varicose veins, a condition in which the veins become enlarged and twisted. RFA can close off the affected vein and redirect blood flow to healthy veins. 
  • Cardiac arrhythmia treatment: RFA can be used to treat certain types of cardiac arrhythmias, or irregular heart rhythms, by destroying small areas of heart tissue that are causing the arrhythmia. 
  • Kidney and liver disease treatment: RFA can be used to treat certain types of kidney and liver diseases, including cancer and benign tumors. 

RFA is typically considered when other treatments have failed or are not appropriate for the patient’s condition. 

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What conditions can be treated with radiofrequency ablation?  

Radiofrequency ablation (RFA) is a versatile medical procedure that can be used to treat a range of medical conditions. Besides those mentioned in the previous section, RFA may also be a suitable treatment for the following: 

  • Trigeminal neuralgia: Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, which is responsible for transmitting sensations from the face to the brain. It is characterized by sudden, severe, and sharp pain that is usually triggered by everyday activities such as eating, drinking, or touching the face. Trigeminal neuralgia can affect one or both sides of the face, and the pain can last from a few seconds to several minutes. It is more common in women and in people over the age of 50. 
  • Spinal cord pain: Spinal cord pain is a type of chronic pain that affects the back and legs. It can be caused by a variety of conditions, such as herniated discs, spinal stenosis, arthritis, or nerve damage. Spinal cord pain is often described as a dull ache or a burning sensation that can radiate down the legs or into other parts of the body. It can also be accompanied by muscle weakness, numbness, or tingling. 
  • Headaches: Headaches are a common condition characterized by pain or discomfort in the head or neck. They can range from mild to severe and can be caused by a variety of factors, including tension, sinus pressure, migraine, or underlying health conditions. 
  • Thyroid nodules: Thyroid nodules are abnormal growths or lumps that form within the thyroid gland, which is located in the neck and produces hormones that regulate the body’s metabolism. Thyroid nodules are very common, affecting up to 50% of the population, and are typically noncancerous. 

Who is a candidate?  

A good candidate for radiofrequency ablation (RFA) depends on the specific condition being treated. Generally, patients who have chronic pain that is not responding to other treatments, such as medications or physical therapy, may be considered for RFA. 

Patients who are generally in good health and do not have any medical conditions that would increase their risk for complications may be good candidates for RFA. They should also have realistic expectations for the procedure and be willing to follow post-procedure instructions to optimize their outcomes. 

Who performs the procedure?  

Radiofrequency ablation (RFA) is typically performed by an interventional pain management specialist, who is a medical doctor with specialized training in diagnosing and treating chronic pain conditions. These specialists may include anesthesiologists, physiatrists, or neurologists who have completed additional fellowship training in interventional pain management. 

What happens before treatment?  

Before a radiofrequency ablation (RFA) procedure, the patient will typically undergo a thorough evaluation by a qualified healthcare provider to determine if they are a good candidate for the procedure. This may involve a physical exam, review of medical history, and diagnostic imaging tests, such as X-rays or MRIs. 

If the patient is a good candidate for RFA, the healthcare provider will explain the procedure in detail and answer any questions the patient may have. The patient will be instructed on how to prepare for the procedure, which may include restrictions on food and drink before the procedure, and instructions for any medications that should be taken or avoided. 

What happens during treatment?  

During the procedure, the patient can expect to be awake and alert, but may receive local anesthesia, sedation, or general anesthesia to help them relax or sleep during the procedure. The procedure typically takes about 30-60 minutes, but this can vary depending on the location and complexity of the targeted tissue or nerves. 

The healthcare provider will use imaging guidance, such as X-ray or ultrasound, to precisely locate the target area and insert a small needle or probe into the tissue. Radiofrequency energy is then delivered through the needle or probe to heat up and destroy the targeted nerves or tissue. 

The patient may feel a slight warming or tingling sensation during the procedure but should not experience significant pain. The healthcare team will monitor the patient’s vital signs, including blood pressure, heart rate, and oxygen levels, throughout the procedure to ensure their safety. 

What happens after treatment and during recovery?  

After a radiofrequency ablation (RFA) procedure, the patient will typically be monitored for a short time in a recovery area to ensure that their vital signs are stable and that they are not experiencing any adverse effects from the procedure. The patient may feel some discomfort or soreness at the procedure site, but this can usually be managed with over-the-counter pain medications or other pain management techniques. 

The patient should arrange for someone to drive them home after the procedure, as they may still be feeling the effects of any sedation or anesthesia that was used during the procedure. 

Patients should follow post-procedure instructions carefully, which may include: 

  • Rest: Patients may need to take it easy for a few days after the procedure and avoid strenuous physical activity or heavy lifting. 
  • Pain management: Patients may be prescribed pain medications or instructed to use over-the-counter pain relievers to manage any discomfort or soreness at the procedure site. 
  • Ice or heat therapy: Patients may be instructed to apply ice or heat to the procedure site to help reduce swelling and discomfort. 
  • Follow-up appointments: Patients will typically be scheduled for a follow-up appointment with their healthcare provider to assess their recovery and ensure that the procedure was effective in managing their pain. 
  • Activity restrictions: Patients may be advised to avoid certain activities, such as driving or operating heavy machinery, for a period of time after the procedure. 

Most patients are able to return to their normal activities within a few days to a week after the procedure, depending on the location and complexity of the targeted tissue or nerves.  

What are the risks and success rate? 

Radiofrequency ablation (RFA) is generally considered a safe and effective procedure for the treatment of various conditions. However, as with any medical procedure, there are some potential risks and complications that patients should be aware of, including: 

  • Pain or discomfort at the procedure site: Patients may experience some soreness, bruising, or discomfort at the site where the needle or probe was inserted. 
  • Infection: There is a risk of infection at the procedure site, which can usually be managed with antibiotics. 
  • Bleeding: In rare cases, patients may experience bleeding at the procedure site, which may require additional treatment. 
  • Nerve damage: There is a risk of nerve damage, which can cause numbness, weakness, or other neurological symptoms. 
  • Skin burns: There is a risk of skin burns if the radiofrequency energy is not delivered properly or if the procedure is not monitored carefully. 
  • Allergic reaction: Patients may have an allergic reaction to the anesthesia or other medications used during the procedure. 

The overall success rate of RFA varies depending on the specific condition being treated, the location and complexity of the targeted tissue or nerves, and other individual factors. However, many patients report significant relief from pain and other symptoms after the procedure, with some studies reporting success rates of up to 70%. The effectiveness of RFA may also depend on factors such as the patient’s age, overall health, and the duration and severity of their condition. 

Patients should always discuss the risks, benefits, and potential outcomes of RFA with their doctor before the procedure.