Surgical Risks of Cervical Radiofrequency Ablation
Cervical radiofrequency ablation (RFA) carries several significant risks, including dropped head syndrome, nerve injury, hemorrhage, infection, and increased pain, though serious complications are rare when performed according to established guidelines. 1, 2
Common Risks and Complications
Pain and Discomfort: Intraprocedural pain and increased pain during the post-ablation period are common, which is why cervical RFA typically requires general anesthesia 3
Nerve Injury: There is risk of damage to non-targeted neural tissue, which can result in numbness, dysesthesia, or other neurological complications 4
Hemorrhage: Bleeding is a potential complication, though RFA is considered hemostatic and has less frequent bleeding complications compared to some other procedures 3
Infection: As with any invasive procedure, infection at the procedure site is a possible complication 4
Tissue Damage: Thermal injury to surrounding tissues can occur, particularly if the procedure is not performed with proper imaging guidance 2
Severe Complications
Dropped Head Syndrome: This is a rare but potentially debilitating complication of multilevel cervical RFA, characterized by cervical kyphosis and inability to extend the neck 1
Bone Instability: RFA can increase the risk of bone instability, which is why it is often combined with cementoplasty to provide structural support 3
Inadvertent Vascular Injection: During diagnostic blocks performed before cervical RFA, there is risk of inadvertent vascular injections that could lead to seizures or paralysis 2
Risk Mitigation Strategies
Imaging Guidance: Performing the procedure with fluoroscopy, ultrasonography, or computed tomography significantly reduces the risk of injuring non-targeted tissues 4, 5
Proper Patient Selection: RFA should not be used in pregnant women, patients with unstable joints, uncontrolled diabetes mellitus, or those with implanted defibrillators 4
Procedural Technique: Using a lateral approach with a multitined cannula may offer a shorter, less cumbersome procedure with less x-ray exposure and patient discomfort than conventional cervical RFA 5
Anatomical Considerations: When performing RFA within the vertebral body, radiofrequency typically does not penetrate the cortex of healthy bone, which can help protect the spinal cord 3
Long-term Considerations
Nerve Regeneration: Due to the regenerative potential of nerves, the effects of RFA typically last for 1-2 years before pain may return 2
Repeat Procedures: The procedure can be repeated if necessary when pain returns, though each procedure carries its own risks 4
Monitoring: Patients should be followed up regularly after the procedure to assess pain relief and monitor for complications 5, 6
Special Considerations
Electromagnetic Interference: For patients with cardiac implantable electronic devices (CIEDs), special precautions must be taken as RFA can interfere with device function 3
RF Current Path: When performing RFA in patients with CIEDs, the RF current path should be kept as far away from the pulse generator and lead system as possible 3
Proximity Concerns: Direct contact between the ablation catheter and any implanted pulse generator or leads should be avoided 3
While cervical RFA is generally considered safe and effective for managing chronic neck pain when performed by experienced practitioners, the potential risks must be carefully weighed against the benefits for each individual patient based on their specific condition and comorbidities 2.