From the Guidelines
Radiofrequency ablation (RFA) is a recommended treatment option for facet joint degeneration causing chronic back pain, as evidenced by the 2022 American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain 1. The procedure involves using heat generated by radio waves to target and destroy the small nerves that carry pain signals from the facet joints to the brain.
- Patients typically undergo diagnostic medial branch blocks with local anesthetic first to confirm that the facet joints are the pain source before proceeding to RFA, as suggested by the 2020 NICE Guideline on Low back pain and sciatica in over 16s: assessment and management 1.
- The procedure is performed under local anesthesia with light sedation, taking approximately 30-60 minutes.
- A specialized needle is inserted near the targeted nerves under X-ray guidance, and radiofrequency energy heats the tip to 80-90°C for 60-90 seconds per site, creating a lesion that disrupts pain signal transmission.
- Pain relief from RFA typically lasts 6-12 months, sometimes up to 2 years, and the procedure can be repeated when pain returns.
- Side effects are generally mild and temporary, including soreness at the injection site, numbness, and occasional increased pain for a few days.
- RFA works by creating controlled damage to the medial branch nerves that transmit pain signals from the facet joints, effectively interrupting the pain pathway while the nerves regenerate over time. It is essential to note that the outcomes of radiofrequency denervation have improved due to a deeper understanding of the neuroanatomy of the spine, improved patient selection, and better radiofrequency ablation techniques, as highlighted in the British Journal of Anaesthesia study 1.
- The British Journal of Anaesthesia study also emphasizes the importance of ongoing assessment after a trial of treatment to show evidence of response and close cooperation with other specialties, especially physiotherapy, to rehabilitate patients during the period of pain relief after interventions 1. In summary, RFA is a viable treatment option for facet joint degeneration, and its effectiveness is supported by recent guidelines and studies, including the 2022 ASPN guideline 1.
From the Research
Radiofrequency Ablation for Facet Degeneration
- Radiofrequency ablation (RFA) is a treatment option for facet degeneration, with studies showing its effectiveness in providing long-term pain relief 2, 3, 4, 5.
- The procedure involves the use of heat to damage the nerve endings in the facet joints, preventing them from transmitting pain signals to the brain.
- RFA has been shown to be effective in managing chronic spinal pain, with some studies demonstrating significant improvements in pain relief and functional outcomes 3, 4.
Diagnosis and Treatment of Facet Joint Pain
- Facet joint pain is typically diagnosed based on history and physical examination, combined with a diagnostic block of the medial branches innervating the joints 2, 3, 5.
- Imaging techniques such as MRI, CT, and SPECT may be used to confirm the diagnosis, but are not always necessary 2, 3, 5.
- Treatment options for facet joint pain include conservative management, such as exercise therapy and pharmacological treatment, as well as interventional procedures like RFA and facet joint injections 2, 3, 4, 5.
Efficacy of RFA for Facet Degeneration
- Studies have demonstrated the efficacy of RFA in providing long-term pain relief for patients with facet degeneration, with some showing significant improvements in pain relief and functional outcomes 3, 4.
- The level of evidence for RFA is moderate to strong, with multiple studies demonstrating its effectiveness in managing chronic spinal pain 3, 4.
- However, more research is needed to fully understand the efficacy and safety of RFA for facet degeneration, as well as to determine the optimal treatment protocols and patient selection criteria 3, 6, 4.