What is the procedure called that ablates nerves for back pain, specifically Radiofrequency Ablation (RFA)?

Radiofrequency Ablation (RFA) for Back Pain

Radiofrequency ablation (RFA) is the procedure that ablates nerves for back pain by using heat generated from medium-frequency alternating current to interrupt pain signals in spinal nerves. 1

Types of RFA for Back Pain

RFA can be performed in several ways depending on the target nerves and pain source:

• Conventional/Thermal RFA: Uses high temperatures (67-80°C) to create lesions that disrupt pain signal transmission 1

  • Most commonly used for facet joint-mediated pain
  • Targets the medial branch nerves that innervate facet joints

• Cooled RFA: Uses internally cooled electrodes that allow for larger lesion creation while maintaining electrode tip temperature 2

  • Often used for sacroiliac joint pain

• Bipolar RFA: Creates a strip lesion between multiple electrodes 2

  • Can be used for sacroiliac joint pain
  • Reduces procedure time and radiation exposure compared to cooled RFA

• Pulsed RFA: Uses short bursts of current with cooling periods between pulses

  • Less destructive than conventional RFA

Clinical Indications

RFA is primarily indicated for:

1. Facet Joint Pain (lumbar, thoracic, and cervical) 1, 3

   • Characterized by pain exacerbated by extension but not flexion
   • Localized tenderness over facet joints
   • Lack of radicular symptoms

2. Sacroiliac Joint Pain 1, 2

   • Targets lateral branches of S1-S3 dorsal rami and L5 dorsal ramus

3. Discogenic Pain (emerging application) 4

   • Targets basivertebral and sinuvertebral nerves
   • Recent meta-analysis shows significant improvements in pain control and disability

Patient Selection Criteria

For optimal outcomes, patients should meet the following criteria 3:

• Chronic pain limiting activities of daily living for ≥6 months
• Failed conservative treatment for ≥6 weeks
• No prior spinal fusion at treatment levels
• Negative neuroradiologic studies for disc herniation requiring surgery
• No significant vertebral canal narrowing requiring surgery
• Most importantly: Positive response to diagnostic medial branch blocks

Efficacy and Duration

• For facet joint pain: Strong evidence supports RFA with 5 of 6 RCTs demonstrating statistically significant pain reductions 5
• For sacroiliac joint pain: Both RCTs examining this application showed statistically significant pain reductions 5
• For discogenic pain: Evidence is mixed 5, 4
• Duration of relief typically ranges from 6-12 months 3
• Approximately 45-66% of patients report at least 50% pain relief at long-term follow-up 3

Procedure Technique

The American Society of Anesthesiologists recommends 1:

1. Conventional (80°C) or thermal (67°C) radiofrequency ablation of the medial branch nerves for low back pain
2. Conventional radiofrequency ablation for neck pain
3. Water-cooled radiofrequency ablation for chronic sacroiliac joint pain

Repeat Procedures

Current guidelines support repeat RFA procedures when 3:

• Initial RFA provided significant pain relief (>50%)
• Pain has returned after expected duration of relief (typically 6-12 months)
• Same anatomical structures are involved
• Repeat diagnostic blocks are not necessary if previous treatment was successful

Safety Considerations

• RFA is generally considered safe with rare complications 3
• Special precautions are needed for patients with implanted medical devices due to potential electromagnetic interference 6
• Conventional or thermal radiofrequency ablation of the dorsal root ganglion should not be routinely used for lumbar radicular pain 1

Important Clinical Caveats

• Chemical denervation (e.g., alcohol, phenol) should not be used in routine care of patients with chronic non-cancer pain 1
• Other treatment modalities should be attempted before consideration of ablative techniques 1
• Patients should be informed that RFA effects are temporary and may require repeated procedures 3

RFA represents an important interventional option for chronic back pain when conservative measures fail and diagnostic blocks indicate potential benefit.