RADIOFREQUENCY ABLATION (RFA)

FREQUENTLY ASKED QUESTIONS

What are the Spinal Facet Joints?

What are the Medial Branch Nerves?

What is a Medial Branch Block (MBB)?

What is a Radiofrequency Ablation (RFA)?

Are Radiofrequency Ablations Painful?

Can I be put to “Sleep” for an RFA?

Can I have any Sedation for an RFA?

Are there any Risks with IV Sedation?

Will an RFA make all my Pain go Away?

How Long until the RFA Starts to Work?

How Long will Pain Relief last after an RFA?

How many RFAs will I need?

What if the RFA does not Help my Pain?

What are the Risks of an RFA?

What are the Side Effects of Steroids?

Do I Need to Stop any Medication for the RFA?

What Happens on the Day of the RFA?

What Happens After the RFA?

 

 

What are the Spinal Facet Joints?

  • Spinal facet joints are a pair of joints on the posterior aspect (back side) of the spine.

  • These small joints assist in the movement and stability of the spine.

  • These joints can also be a source of pain in the neck/back.

 

What are the Medial Branch Nerves?

  • Medial Branch Nerves are the small nerves that “supply” the spinal facet joints.

  • Any pain signal from an arthritic facet joint must first travel through these nerves.

 

What is a Medial Branch Block (MBB)?

  • Spinal Facet Joint Arthritis is considered a normal aspect of aging.

    • As a result, imaging studies (X-Rays, MRIs, CT Scans) often show facet joint arthritis.

    • However, facet joint arthritis does not always cause pain.

  • MBBs are a DIAGNOSTIC PROCEDURE to determine if the facet joints are causing pain.

    • MBBs involve injecting numbing (anesthetic) medication onto the medial branch nerves.

    • Goal: Temporarily “block” any pain signals coming from the facet joints

  • Two possible outcomes from an MBB

    • Outcome 1: Typical Spine Pain improves significantly after the MBB

      • Conclusion: Pain is coming from the facet joints

    • Outcome 2: Typical Spine Pain does not improve significantly after the MBB

      • Conclusion: Pain is not coming from the facet joints.

  • If MBBs help, a radiofrequency ablation can be performed to burn the medial branch nerves.

  • If the MBB does not help, an RFA procedure will not provide any benefit.

    • Your provider will discuss other treatment options to help your pain.

 

What is a Radiofrequency Ablation (RFA)?

  • RFAs are designed to burn the medial branch nerves.

  • Burning these nerves cuts the communication between the painful facet joints and the brain.

    • Sensations of pain coming from the facet joints no longer reach the brain.

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Are Radiofrequency Ablations Painful?

  • Most individuals tolerate RFAs well with little discomfort.

  • If any discomfort is felt, it is usually short-lived and tolerable.

  • If you feel any significant discomfort during the procedure, tell your doctor.

 

Can I be put to “Sleep” for an ESI?

  • Stone Med DOES NOT recommend general anesthesia for any spinal procedure.

  • Risk of complications increases if an individual is “put to sleep”.

 

Can I have any Sedation for an ESI?

  • Individuals may choose to have “light” IV sedation for their injection.

  • Light sedation is not designed to put you completely to sleep.

  • Goal of Sedation: Reduce pain/anxiety enough to make the procedure more comfortable

  • Decision to have sedation is up to the individual having the procedure, not the doctor.

 

Are there any Risks with IV Sedation?

  • IV sedation increases the risk of nausea and vomiting during the procedure.

  • Vomiting while sedated may cause you to aspirate (inhale) some vomit into your lungs.

    • Could cause a serious pneumonia, requiring antibiotics and possible hospitalization.

  • Risk of aspiration is significantly reduced if you do not eat or drink prior to the procedure.

    • Do not eat for 6 hours prior to the procedure.

    • Do not drink for 4 hours prior to the procedure.

 

Will an RFA make all of Pain go Away?

  • Goal: Reduction of pain enough to allow the individual to regain quality of life and function

  • While it is possible to obtain complete pain relief after an RFA, this is not always possible.

  • Response to the MBBs is a good indication of pain relief expectations with the RFA.

    • Improvement felt after the MBBs should mimic the improvement felt after an RFA.

 

How Long until the RFA Starts to Work?

  • Unlike the MBBs, pain relief after an RFA is often not felt immediately.

  • Most individuals start to feel pain relief within 1-2 weeks after the RFA is performed.

  • In some cases, it may take up to 4-6 weeks after the RFA to feel any benefit.

  • Once pain levels start to decrease, the pain will continue to gradually decrease with time.

    • Maximum improvement usually occurs around 2-3 months after the procedure.

 

How Long will Pain Relief last after an RFA?

  • An RFA is designed to treat any pain associated with painful facet joints in the spine.

  • As long as the pain is coming from the facet joints, RFAs can provide long lasting pain relief.

  • Expected duration of pain relief from an RFA is, at minimum, 1-2 years.

  • Unfortunately, facet joint pain often returns following an RFA.

    • Even though the medial branch nerves are burned, the main nerve does not die.

    • The nerve fibers of the medial branch nerve will start to regenerate slowly.

    • If regenerated neurons eventually grow back into the arthritic facet joint, pain may return.

    • If this should occur, it may be necessary to repeat the RFAs again in the future.

 

How many RFAs will I need?

  • One the RFA has been performed, no other treatments for the facet joints are required.

  • Unfortunately, the medial branch nerves can slowly regenerate and grow back over time.

  • If the nerve grows back into the facet joint, it is possible for facet pain to return in the future.

    • If this should occur, it may be necessary to repeat the RFA again.

 

What if the RFA does not Help my Pain?

  • Not a typical issue, as long as the MBBs prior to the RFA provided significant benefit for pain.

  • As long as the RFA is performed well, it should provide significant pain relief.

  • Remember, the benefit of the RFA does not always occur immediately.

    • It can take many weeks before you start to feel pain relief.

  • The RFA may not provide complete relief of all your neck/back pain.

    • RFAs only help pain related to spinal arthritis.

    • RFAs do not help with pain associated with discs, pinched nerves, spinal stenosis, etc.

  • If you continue to have pain after RFA, there are likely other conditions that need treatment. 

 

What are the Risks of an RFA?

  • All injections have possible risks, side effects, and complications.

    • When performed correctly, all the following risks are rare.

PAIN

  • RFAs usually do not cause significant discomfort during the procedure.

  • Usually, any increased discomfort usually lasts less than 24 hours.

  • There are rare occasions when the burned nerve can flare up after the procedure.

    • If you have significant pain that does not resolve after an RFA, call your doctor.

BRUISING

  • Superficial bruises resolve without any specific treatment.

  • More common in older individuals and those taking blood thinning medications.

INFECTION

  • Minimal risk, as we thoroughly clean the skin prior to every injection.

  • All needles are brand new (never reused) and opened just prior to the injection.

BLEEDING

  • Excessive bleeding is rare, even if the needle hits a deeper blood vessel near the spine.

    • Any bleeding should stop on its own without complications.

  • Risk of bleeding increases if:

    • You have a genetic bleeding disorder.

    • You are taking medications that thin your blood.

PACEMAKER/DEFIBRILLATOR

  • The radiofrequency generator puts out electrical current, which can set off a defibrillator.

  • We can temporarily disable a defibrillator by placing a strong magnet over the unit.

    • If we do not disable the device, it may fire during the procedure.

NERVE DAMAGE

  • Very Rare Complication with RFAs

  • The only nerves that we want to burn during this procedure are the medial branch nerves.

  • If the RFA needle is too close to a major spinal nerve, these nerves could be damaged.

    • Result: Severe Nerve Pain, Numbness, Weakness

  • To prevent this complication from occurring, nerve testing is performed prior to the burn.

  • Once the needles are placed on the spine, a low electrical current is put though the needle.

  • If the needles are placed correctly over the medial branch nerves:

    • You will feel a tap, tingle, or pressure like sensation in the neck/back region.

    • This response confirms correct needle placement over the medial branch nerves.

  • If the needle is placed incorrectly too close to the spinal nerve:

    • You would feel pain shooting down your arm or leg.

    • If this happens, the needle must be moved to the correct position before the ablation.

  • This Nerve testing is done for two reasons:

    • To ensure that the proper medial branch nerve is burned, relieving pain.

    • To ensure that the spinal nerve is not burned.

SEIZURES, DEATH

  • Extremely Rare Complications

  • Even if all precautions are taken, these severe complications are never reduced to zero.

 

What are the Side Effects of Steroids?

  • Steroid medications are not typically used during RFA procedures.

 

Do I Need to stop any medication for the RFA?

Blood Thinning Medications

  • Blood thinners are often stopped about 3-7 days prior to spinal injections.

  • Tell your provider if you are taking any blood thinning medications.

    • Examples: Coumadin (Warfarin), Pradaxa, Eliquis, Xarelto, Plavix, Aspirin, etc.

  • These medications are usually prescribed for serious medical conditions.

    • We will contact the prescribing doctor to ensure that it is safe to temporarily stop these medications for your procedure.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

  • NSAIDs are often stopped about 5-7 days prior to spinal injections.

    • These medications can increase the risk of bleeding.

  • Tell your provider if you are taking any NSAIDs.

    • Examples: Ibuprofen (Advil, Motrin), Naproxyn (Aleve, Naprosyn), Indocin (Indomethacin), Lodine (Etodolac), Relafen (Nabumetone), Meloxicam (Mobic), Diclofenac (Voltaren), etc.

  • Celebrex (Celecoxib) is an NSAID that does not significantly increase the risk of bleeding.

    • Celebrex does not have to be stopped prior to injections.

Supplements

  • Many natural supplements can affect clotting pathways, increasing the risk of bleeding.

  • For safety, please stop taking supplements for at least 5 days prior to your injection.

    • Examples: Fish Oil, Vitamin E, Ginko Biloba, Ginseng, Garlic, St. John’s Wort

Other Medications

  • Do not stop taking any medications unless youare specifically told to stop.

  • If you have any questions about taking a certain medication, ask your provider.

 

What Happens on the Day of the RFA?

Where do I go?

  • All RFAs are performed in an outpatient ambulatory surgery center.

  • The address and phone number of the surgical center will be provided to you.

When Should I Arrive?

  • Please arrive at least 15 minutes prior to your appointment to get checked in.

How Long will the Procedure Take?

  • Expect your appointment to last around one hour from arrival to discharge.

Should I Take my Blood Pressure Medications?

  • Yes; these medications do not thin your blood. Take them always.

Can I Eat or Drink prior to the Procedure?

  • If you are not having Sedation, you can eat and drink before the procedure.

  • If you want Sedation:

    • Do not eat for 6 hours prior to your procedure.

    • Do not drink for 4 hours prior to your procedure.

      • You may take your medications with small sips of water.

Can I Drive Myself to the Procedure?

  • If you are not having Sedation, you may drive yourself or use a Taxi/Uber/Lyft service.

  • If you are having Sedation, you MUST have a adult over 18 years old to drive you home.

    • You cannot use a Taxi/Uber/Lyft service unless you have an adult with you.

    • Your driver must remain at the surgery center throughout the entire procedure.

      • Your driver is not allowed to leave and come back later to pick you up.

      • Individuals have been left at the surgery center with no way home (sad but true).

 

What Happens After the RFA is Performed?

ACTIVITY

  • On the day of the injection, you may resume normal, everyday activities.

  • Try to avoid strenuous lifting/activities for about 2-3 days after the procedure.

MEDICATIONS

  • You may take pain medications immediately after your injection, if needed.

  • You may resume NSAIDs, Aspirin and other blood thinners the following morning.

PAIN

  • You may use ice over the injection site, 20 minutes on, 20 minutes off, repeating as needed.

EATING/DRINKING

  • You may eat and drink immediately after your injection is finished.

WATER/BATHS/SHOWER

  • You may shower the evening of your procedure, if desired.

  • Avoid submerging the injection site under water for 24 hours to reduce any risk of infection.

    • No Baths, No Swimming Pools, No Hot Tubs, etc.

CALL YOUR DOCTOR IF YOU DEVELOP ANY OF THE FOLLOWING:

  • Fever/Chills

  • Drainage/Other Signs of Infection

  • Excessive Swelling or Redness at the Injection Site

  • New/Worsening Severe Pain

  • New/Worsening Bowel/Bladder Dysfunction

  • New/Worsening Numbness/Weakness

  • New Headache that does not Resolve on its own

FOLLOW UP

  • Typically, you will be seen in the office about 2 weeks after the injection.

  • If you have not made a follow up, please call the Stone Med office to set up this appointment.