Radiofrequency neurotomy (RFN)
What is RFN/RFA?
Radiofrequency neurotomy (RFN) is a procedure where radio waves are used to create heat and destroy part of a nerve that supply your facet joints. This techniques is most commonly used to stop the nerves that provide sensation to the facet joints from sending the pain signal to the brain, which may subsequently reduce the pain.
A facet joint is a small, bony knob that connects the two vertebrae and is surrounded by small nerves called medial branch nerves that provide sensation to each facet joint. These nerves carry the pain signals from the facet joint to the spinal cord. Eventually, these signals reach the brain where you feel the sensation of pain. These small nerves usually grow back in 9 to 12 months.
How do I prepare for the procedure?
Medication changes. Please inform the doctor if you take any blood thinners, or have any allergies to medications. You may be asked to stop or change the dose of certain medications for several days before the procedure. Always ask your primary physician before stopping any medications.
Food and drink. Do not eat or drink for 6 to 8 hours before the procedure, as sedation might be provided.
Transportation. You will not be allowed to drive home, bring a driver with you to your appointment.
Clothing and Hygiene. You may wish to wear loose fitting clothing that is easy to take off and put on. You may want to shower the morning of the procedure. Do not wear jewelry or any type of scented oil or lotions.
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What happens during the RFN?
Position. You will lie face down on an operating table.
Sedative. Sedation is not routinely administered. However, you may be given a mild sedative to help you relax. IV will be started to allow the doctor to give you any medications that may be needed during the procedure.
Local Anesthetic. You will be given a local anesthetic to numb your skin near the injection site.
Positioning the needle. Your doctor will insert a thin needle near the facet joint that is causing the pain, using an x-ray to help position the needle in the best place. Each joint has two medial branch nerves, so each joint treated will have two needle positions.
Pain medication. Your doctor will inject more pain medication close to the nerves being treated to help with any discomfort.
Radiofrequency pulse. Your doctor will use radiofrequency energy to disable the medial branch nerve. The procedure will be repeated at each needle position.
Fluoroscopic guidance. The fluoroscope is an X-ray machine that allows the doctor to actually see an X-ray image while performing the procedure. This allows the doctor to monitor the position of the needle electrode.
When will I feel relief - and how long will it last?
About half the people who have radiofrequency neurotomy feel pain relief, and it can take up to 4 weeks to feel it. The pain relief should last 6 to 16 months. After that, the treated nerves can begin to grow back, and the pain may or may not return. If the pain does return, physical therapy and greater muscle strength around the joint may help ease the pain. If necessary, another radiofrequency neurotomy can be repeated.
What happens after?
You may have your vital signs (heart rate, blood pressure, breathing rate) monitored for up to 30 minutes after the injection. You may also note some swelling and bruising wherethe needle was inserted. Using a cold pack may ease the discomfort.
You may feel sore from the injection for 1 to 4 days. Your back may feel numb, weak, or itchy for a couple of weeks. Your pain may flare up and feel worse for a few days before it starts to feel better. It may take 3 to 4 weeks to feel the full pain relief of the neurotomy.
Be SURE to follow up with your doctor in one to two weeks. Your doctor needs to know how well the procedure worked and if you need additional treatment.
When should I call the doctor?
Once you go home, you should gradually start to feel better. Call your doctor if you’re concerned about your progress, or if you have any of these symptoms:
• Severe back pain
• Fever or chills
• Increase in pain that is not getting better within two weeks
Why do I need it?
There are various structures in the spine that can cause pain. One of the most common pain source is the facet joint. The goal of radiofrequency ablation (RFN) is to destroy the small nerves that carry the pain signal from the joint to the spinal cord, which subsequently reduce your pain, and allow you to perform more activity.
This procedure is usually done only after you have had two successful facet joint injections called medial branch blocks (MBBs). This MBBs are done to determine if the facet joints are the cause of your pain and it is only for diagnostic purposes. The injection may only reduce the pain for a short period, maybe only for a few hours. If you have pain relief from the injection, radiofrequency ablation (RFN) is done to reduce your pain for a longer period of time. RFN is not a permanent fix, but it provides longer lasting relief.