Radiofrequency nerve ablation (RFA)

• Medial branch neurotomy: Targets the tiny medial branch nerves that transmit pain signals from the facet joints (the small articulating joints along the back of the neck and spine).
• Lateral branch neurotomy: Targets the lateral branch nerves carrying pain signals from the sacroiliac (SI) joints (the joints connecting the lower spine to the pelvis).

RFA is primarily recommended for persistent joint-mediated pain that has failed to improve with conservative management:

• Facet joint arthritis and pain: Chronic neck (cervical), mid-back (thoracic), or lower back (lumbar) pain aggravated by twisting or bending backward.
• Sacroiliac joint dysfunction: Chronic lower back, buttock, or hip pain arising from SI joint inflammation or hypermobility.
• Spondylosis: Degenerative arthritis of the spine causing localised, persistent back stiffness and ache.
• Cervicogenic headaches: Persistent headaches originating from arthritic upper cervical facet joints.

Radiofrequency ablation is performed as a day-case procedure in a specialised treatment room or operating theatre. You will be able to return home the same day.

Before the procedure (Diagnostic nerve blocks)

Before undergoing RFA, you will have one or two diagnostic nerve block injections (using local anaesthetic). This confirms that your pain is genuinely originating from specific facet or sacroiliac joints. If the diagnostic block provides temporary but significant pain relief, your consultant will confirm that you are a suitable candidate for radiofrequency ablation.

During the procedure

1. Preparation and sedation: You will lie comfortably face down on an X-ray table. A local anaesthetic is applied to numb the skin over your back or neck. A mild sedative is often administered so you remain calm and relaxed, though awake enough to respond.
2. Precision needle placement: Using live X-ray guidance (fluoroscopy), the specialist inserts fine, specialised needles into the exact location of the target medial or lateral branch nerves.
3. Nerve location verification: A tiny microelectrode is passed through the needle. Small electric stimulation tests are performed, producing a mild tingling or muscle-twitching sensation. This confirms the needle is precisely positioned on the target sensory nerve and safely away from major motor nerves.
4. Thermal ablation: Local anaesthetic is injected through the needle to numb the nerve, followed by a radiofrequency current passed through the electrode tip. The heat (typically 80°C for 60 to 90 seconds) creates a small heat lesion on the nerve tissue.
5. Dressing: The needle is removed, and a small sterile dressing is applied over the puncture site.

The procedure generally takes 30 to 60 minutes, depending on the number of nerve sites being treated.

The procedure is designed to be as comfortable as possible. You may feel a brief sting when local anaesthetic is injected into the skin, and a mild pressure or localized ache when the probe is positioned and activated.

The local anaesthetic administered prior to thermal ablation ensures that heating the nerve tissue is not painful. Post-procedure soreness is common, but it can be easily managed with rest and simple painkillers.

Radiofrequency nerve ablation is a safe, routinely performed intervention. Complications are rare, but potential risks include:

• Post-procedure sunburn-like pain or neuritis: Temporary localised skin tenderness, muscle soreness, or nerve irritation that can last for 1 to 3 weeks before settling.
• Temporary leg numbness or weakness: Caused by local anaesthetic spreading to nearby motor nerves during the procedure; this resolves within a few hours.
• Incomplete pain relief: RFA provides substantial relief for most patients, but occasionally a nerve may not be fully ablated.
• Localised infection or bleeding: Minor risk at the needle insertion sites (less than 1 in 1,000 cases).
• Allergic reaction: Minor reactions to antiseptic solutions, contrast dye, or medications used.

Your specialist will discuss all potential risks with you in detail during your consultation.