Radiofrequency Neurotomy

What is radiofrequency neurotomy?

A new type of rhizotomy, radiofrequency neurotomy is a nonsurgical procedure that uses radio waves to help relieve chronic back pain.

It uses needles to send radio waves that generate heat toward the medial or lumbar branch nerves. This destroys the pain-causing nerves and 'turns off' their ability to send pain signals.

The procedure is also called radiofrequency ablation. It is used for joint pain in the cervical, thoracic, lumbar and sacral spine, as well as for the hips and knee joint.

Why do you need radiofrequency neurotomy?

You may need radiofrequency neurotomy if you have chronic back pain that has not improved with medications or physical therapy, or when surgery is not an option.

Chronic pain is pain that lasts for more than 12 weeks, even after treatment or medication.

Radiofrequency neurotomy can help patients who suffer from pain that:

• Is associated with osteoarthritis
• Results from injury to the back
• Occurs on one or both sides of the lower back
• Spreads to the buttocks and thighs (but does not reach the knees)
• Feels worse if you twist or lift objects
• Feels better when lying down

Radiofrequency neurotomy might also be recommended to treat neck pain associated with whiplash.

What are the risks and complications of radiofrequency neurotomy?

Radiofrequency neurotomy is a nonsurgical, minimally invasive procedure.

Common side effects include:

• Temporary numbness
• Temporary pain at the procedure site

Rarely, more-serious complications may occur, including:

• Bleeding
• Infection
• Nerve damage
• Worsening pain

How do you prepare for radiofrequency neurotomy?

Before radiofrequency neurotomy, your doctor will review your medical history. You may also undergo some scans and tests such as:

• Physical examination
• X-rays
• Magnetic resonance imaging (MRI)

Your doctor will also do a test to determine if the type of pain you have will be responsive to the treatment.

You will be given two rounds of diagnostic nerve blocks to:

• Identify and confirm the source of the pain
• Assess the potential level of relief
• Determine if radiofrequency neurotomy will be effective

If the nerve block does not result in pain relief, radiofrequency neurotomy may not be recommended.

Once your radiofrequency neurotomy is scheduled, your doctor will advise you on how to prepare.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

What you can expect in radiofrequency neurotomy?

Radiofrequency neurotomy is usually an outpatient procedure and you may go home on the same day.

Before the procedure

This procedure is done using local anaesthetic and you may be sedated so that you are comfortable and calm.

During the procedure

During radiofrequency neurotomy:

• You will be asked to lie on your front on a special table that has an X-ray (fluoroscope) function
• Your back will be cleaned and the identified treatment areas marked out
• You will be given a local anaesthetic to numb the area
• X-rays will be used to guide the placement of the radiofrequency needles
• Once the needles are confirmed to be in the correct place, a small electrical current is passed through the needle to target the pain-causing nerves
• As this happens there may be some pain or muscle twitching in the back, buttock and legs

After the procedure

You may go home after the procedure, but it is advisable to have someone drive you.

Most people take 1 – 2 days to resume regular activities.

Care and recovery period for radiofrequency neurotomy

It is normal to feel some soreness, numbness or a sunburn-like pain right after radiofrequency neurotomy.

During the first day after the procedure:

• Use an ice pack, 20 minutes at a time about 3 – 4 times a day to soothe the procedure site
• Avoid using a heating pad on the procedure sites
• Take a warm shower 24 hours after the procedure – avoid soaking in a bath for at least 2 days

Some pain and discomfort may linger for up to a week.

You may be prescribed medication and recommended physical therapy to help manage the pain and regain function.