What does spinal ablation do?

Spinal Ablation: Mechanism, Effectiveness, and Risks

Spinal ablation procedures are not recommended for chronic non-cancer spine pain as they provide little to no benefit over sham procedures while carrying risks of harm and significant costs. 1

What Spinal Ablation Does

Spinal ablation is a minimally invasive procedure that uses thermal energy to interrupt pain signals by damaging specific nerves that transmit pain from the spine. The primary mechanisms include:

• Radiofrequency ablation (RFA) uses heat generated from alternating current to destroy targeted nerve tissue, causing Wallerian degeneration of the nerve fibers 2
• The procedure targets specific nerves depending on the pain location:
  • Medial branch nerves for facet joint pain 1
  • Basivertebral nerves for vertebrogenic pain 3
  • Dorsal root ganglion for radicular pain 1

Types of Spinal Ablation

Different techniques are used depending on the clinical situation:

• Conventional (thermal) radiofrequency ablation: Uses high temperatures (67-80°C) to ablate nerves 1
• Water-cooled radiofrequency ablation: Used primarily for sacroiliac joint pain 1
• Cryoablation: Uses extreme cold to damage nerve tissue 1
• Chemical denervation: Uses agents like phenol or alcohol (not recommended for routine use) 1

Effectiveness for Chronic Pain

Recent high-quality evidence strongly suggests against using spinal ablation for chronic spine pain:

• For chronic axial spine pain (≥3 months), strong recommendations exist against joint radiofrequency ablation with or without joint-targeted injections 1
• For chronic radicular spine pain (≥3 months), strong recommendations exist against dorsal root ganglion radiofrequency with or without epidural injections 1
• Current evidence suggests these procedures are no more effective than sham procedures for chronic spine pain 1

Potential Risks and Harms

Spinal ablation carries various risks that must be considered:

• Common moderate harms (low to very low certainty evidence):

  • 8.6% risk of prolonged pain or stiffness (>48 hours) 1
  • 2.1% risk of temporary altered level of consciousness 1
  • 1.4% risk of dural puncture 1
  • 0.7% risk of deep infection 1

• Rare but severe complications:

  • Permanent neurological injury including paralysis (case reports exist) 4
  • Spinal cord injury 1
  • Infection resulting in meningitis 1

Practical Considerations

If considering spinal ablation despite the evidence against it:

• The effects are temporary due to nerve regeneration capacity, typically lasting 1-2 years 2
• Procedures are costly (US$1,000-$6,000 per treatment) 1
• Requires repeated treatments:
  • Injections typically repeated every 2 weeks to 3 months 1
  • Nerve ablation procedures typically repeated every 6 months 1

Current Recommendations

The most recent and highest quality evidence (2025 BMJ guideline) strongly recommends against using interventional procedures including spinal ablation for chronic spine pain:

• Strong recommendations against joint radiofrequency ablation for chronic axial spine pain 1
• Strong recommendations against dorsal root ganglion radiofrequency for chronic radicular spine pain 1
• These recommendations apply to chronic pain (≥3 months) not associated with cancer or inflammatory arthropathy 1

Common Pitfalls

• Overutilization despite limited evidence: There has been a 131% increase in lumbar radiofrequency procedures from 2007 to 2016 despite limited evidence of effectiveness 1
• Financial incentives may drive overuse: Substantial reimbursement for these procedures may act as a perverse incentive for their delivery 1
• Patient selection: The 2010 ASA guidelines note that other treatment modalities should be attempted before consideration of ablative techniques 1