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Radiofrequency neurotomy is a technique to reduce back and neck pain. It makes use of heat generated by radio waves to damage specific nerves and temporarily interfere with their ability to transmit pain signals. In radiofrequency neurotomy, the radio waves are delivered to the targeted nerves by needles inserted through the skin above the spine. Imaging scans are used during radiofrequency neurotomy to help the doctor position the needles accurately. Radiofrequency neurotomy works better in some cases than in others. Tests are required to determine if the nerves commonly targeted by radiofrequency neurotomy are the same nerves responsible for the pain. Radiofrequency neurotomy is commonly performed by doctors specializing in the treatment of pain. The objective is to temporarily reduce chronic pain in the back or neck that hasn't been adequately relieved by other means, such as medications or physical therapy.
Radiofrequency neurotomy (RFN) is a well established treatment procedure for surface joint pain, which was previously diagnosed. Sometimes, facet joint injection is used as a surrogate for the diagnostic component of the test. The notion of the treatment is that when local anesthetic is placed either in the joint or adjacent to the nerve supply of the joint. Pain from the joint is eliminated for the duration of this anesthetic, i.e. usually 1-6 hours.The assurance whether the diagnostic procedure actually produces a positive result is dependent on the interpretation. The criterion for absolute confidence involves 100% pain relief for the few hours when the surgery is being performed. It is essential that the diagnostic procedures are performed accurately. Facet joint injections are particularly challenging. Most facet joints can only take 0.5 – 1.0 ml of material before the joint is ruptured. In order to know whether the injection is indeed inside the joint, contrast material is the first part of the injection.
How is the procedure done?
RFN is performed under sterile conditions in an operating theatre using mild sedation and local anesthetics. Fluoroscopic x-ray allows the surgeon to precisely locate the radiofrequency probe adjoining the medial branch nerves to be treated. The nerve is then heated to 80-90 degrees centigrade using a radiofrequency generator. The facet joints can be the contributing cause or even the sole cause of the pain. If they joints are the lone cause, the RFN may produce total pain relief. If they are a contributing cause, the patient will feel much better.
How to prepare for the surgery?
To determine if one is a good candidate for radiofrequency neurotomy, the doctor may perform a preliminary test to check if the nerves commonly targeted by the procedure are the same nerves causing pain. The diagnostic test involves inserting a small amount of numbing medication into the precise spots where the radiofrequency needles will go. If the pain significantly lessens, radiofrequency treatment at those spots may help to a great extent. Radiofrequency neurotomy is an outpatient procedure. The entire procedure usually takes about an hour. The patient will wear a hospital gown and lie on his/her stomach on an X-ray table. A special kind of X-ray machine called a fluoroscope will help the doctor position the radiofrequency needles precisely so that only the targeted nerve tissue is affected.
An intravenous line will be placed in the patient’s arm or hand to deliver medication that will keep him comfortable during the procedure. Numbing medication will be injected into the skin before the radiofrequency needles are inserted. Prior to the actual radiofrequency neurotomy procedure, the patient should:
- Inform the doctor if taking blood thinners
- Arrange for someone to drive home
- Follow any eating or drinking restrictions summarized by doctor
- Take regular medicines as directed by the surgeon
What are side-effects?
- Allergic reaction to anesthesia is rare but possible. The anesthetic has already been used in previous injections to diagnose the condition. If the side-effect develops, it can be managed in the operating room by the specialist anesthetist.
- Bleeding and bruising are common but in around 5% of cases, the pain from the procedure itself can be prominent for up to a week. The pain can be managed with heat or ice compresses.
- Infection is unlikely thanks to the use of sterile techniques in an operating theatre. The needles are all disposable.
- Post procedural neuropathic pain is a rare occurrence, but when it occurs, it can be severe. It develops particularly when the treated nerve is one that also supplies sensation to the skin. The pain is best managed with a combination of analgesic medications and anti-neuropathic medications.
After the procedure
After the procedure, the patient will be taken to another room to rest until he/she feels well enough to go home. He might feel some soreness in the area where the needles were injected, but it goes away in a few days. The patient is discharged from the hospital within two hours of the surgery and may resume normal activities from the next day. Simple painkillers may be required. Patients who have been using stronger painkillers generally require stronger doses for a few days. If patients develop neuropathic pain after the surgery, other medications may be required. Neuropathic pain can be effectively cured with medications that alter neural conductivity. Patients are advised to maintain mobility with moderate exercise and stretching. Massage and physical therapies can be resumed at any time. However, unless absolutely required for the treatment of post-procedural discomfort, they can be avoided. An appointment for a review is made six weeks post procedure if the pain persists.
Can the RFN be repeated?
On an average, the treatment lasts for at least a year. Scientific studies have shown that around 65% of patients have 95% relief persisting at one-year post treatment, while 90% of patients have at least 70% relief at the same follow-up period. If it wears off, and the same pain recurs, RFN can be repeated ad done on multiple occasions.
Follow-up and care
During the first four days following the procedure, the area where the surgery is performed will usually be sore. The pain is usually caused by muscle spasms and irritability while the targeted nerves are dying from the heat lesion. This process of the nerves dying usually takes about one to two weeks.
Radiofrequency Neurotomy Side Effects
There are several potential side effects following a radiofrequency procedure:
- Depending on the area treated, patients might develop a superficial burning pain with hypersensitivity, similar to a sunburn feeling, over the treated area that lasts for 1 - 2 weeks
- Following this superficial pain, some patients might also experience a light numbness of the skin over the same area.
- On the day following the procedure, the patient may cautiously return to regular activities
- Patients will rest for several days before returning to normal activities, although there are no technical restrictions. Patients are allowed to engage in normal activity.
- Since many patients have been de-conditioned over many months or years as a result of their pain, the physicians might prescribe a guided physical therapy to increase their strength and activity tolerance in a safe manner.