Radiofrequency Ablation

Radiofrequency Ablation (RFA) is also known as rhizotomy or radiofrequency neurotomy. Radiofrequency ablation is a minimally invasive surgery procedure that involves the destruction of a minute amount of nerve tissue in order to treat the source of a patient's pain. The reason this procedure is considered minimally invasive is because it involves a very small skin puncture and because the surrounding areas around the nerve tissue are rarely traumatized.

Radiofrequency ablation may be used in pain management clinics to treat neck pain, lower back pain, and sacroiliac joint pain.

How does Radiofrequency Ablation work? RFA involves the insertion of a probe through the skin and body, into abnormal growths or tissues of the body that are causing medical problems. These medical problems may include nerve tissues that are sending pain signals despite the fact that there is no injury to that area. These medical problems may also include tumors in the lungs and elsewhere, as well as areas of the heart that are creating abnormal cardiac pathways. To restore comfort in the patient or healthy functioning of the organs, the affect material is removed. A high frequency AC current (alternating current) occurs at the end of the probe, which causes the areas around the tip of the probe to heat up. These abnormal or malfunctioning tissues are heated up to the point where they are destroyed.

Because radiofrequency therapy requires the placement of the probe to be in very specific, defined areas, imaging guidance is used during the procedures. Diagnostic exams that may be performed to determine whether or not to go ahead with this type of therapy include X-Ray screening, CT Scan, and Ultrasound. The medical imaging modalities that may be used during radiofrequency neurotomy include X-Ray, Fluoroscopy, and Ultrasound.

This procedure is a second generation technique designed to eliminate back pain and arthritis pain related to specific nerves. In the first generation version of this procedure, the damaged nerved causing the person's pain were severed surgically. These severed nerves would later regenerate themselves, and complication related to their regrowth included the formation of abnormal tissue. This abnormal tissue formation of the nerve fibers often caused more pain than the patient was in before the procedure. These structures were called neuromas when they developed abnormally.



To reduce the risk of these types of complications, new techniques have been developed. Minimally invasive nerve destruction techniques were developed to remove specific sections of the nerve tissue without injuring other nerves or the supportive structures around the nerves. Currently, radiofrequency ablation is the treatment of choice for minimally invasive nerve destruction.

Radiofrequency ablation as a pain management tool is to treat lower back pain associated with arthritis of the facet joints. When RFA is used to treat the facet joints of the lumbar spine, the procedure is called facet denervation.

Facet denervation: Facet denervation may be a two part procedure that includes a diagnostic component, as well as the radiofrequency destruction of the nerve itself. In the diagnostic first part of the procedure, an anesthetic is injected at the nerves thought to be the cause of the pain. This injection is designed to numb the nerves which carry information from the facet joints. If this injection of the numbing agent succeeds in relieving the patient's pain, it is a confirmation of the fact that those nerves are the ones which are responsible for causing the pain. Once these nerves have been confirmed to be the cause of pain, they are treated using radiofrequency lesioning.

When this technique is correctly performed, and no complications develop, it will result in no complications or damage to the nerves carrying motor commands to the muscles.

Another technique is used to treat back pain related to degeneration of the intervertebral discs. Intradiscal electrothermoplasty is also involves the destruction of the nerves that are sending pain signals to the brain. Intradiscal electrothermoplasty involves the insertion of a wire into the discs where the nerves are located. The wire is then heated, destroying the sensory nerves. This procedure may help patients whose cause of their back pain is due to mild to moderate degeneration of the discs. This procedure is rarely effective in treating nerve pain caused by severely degenerated discs.

The treatment benefits, if present, may be only temporary. In time, these nerves do regenerate themselves, and permanently destroying nerves may result in other nerves picking up the sensory message.