Lumbar Radiofrequency Ablation (RFA) Neurotomy

radiofrequency ablation for facet joint pain

Lumbar Radiofrequency Ablation (RFA) Neurotomy

Lumbar Facet Joint Pain

Facet joints are also called zygapophysial joints (z-joints) and are located in the back of the spine.  Therefore, facet joint pain classically worsens while standing and walking, then improves while sitting. Facet joint pain can be felt in the low back or can refer pain into the buttock region and even into the back of the thighs. This referred facet joint pain can be felt on one side or both. Just like any joint in the body, each facet joint surface is covered with cartilage called articular cartilage, which allows the facet joint surfaces to glide smoothly over one another with minimal friction. Due to injury or degenerative wear and tear, this articular cartilage can deteriorate and cause arthritis pain symptoms.  Small-diameter nerve branches, called medial branches, transmit the signals from painful facet joints to the central nervous system. A separate nerve branch services each individual joint surface, so each facet joint involves two distinct medial branches.

Lumbar Facet Joint Treatment – Injection Options

If facet joint pain symptoms persist despite appropriate conservative care, then using fluoroscopic guidance to perform injections becomes an option to consider.  A facet joint steroid injection can interrupt facet joint inflammatory pain symptoms associated with joint degeneration.  A Lumbar Medial Branch Block (MBB) is a diagnostic injection that can verify to what degree spine symptoms can be attributed to the facet joints.  For facet joint pain symptoms that return despite these two injection approaches, then Lumbar Radiofrequency Ablation (RFA) Neurotomy of the corresponding medial branches can be a nonsurgical option to discuss because doing so can provide long-lasting relief.  

Lumbar Facet Joint Injection vs. Lumbar Medial Branch Block (MBB)

There are two injection techniques to determine if a given facet joint(s) is/are contributing to your pain: Medial Branch Block (MBB) Technique or Intraarticular Facet Joint Injection Technique. The MBB numbs the medial branch nerves that service the suspected facet joint(s). After the injection you are given a pain log to take home and compare your pre-injection pain level to what you feel after the medial branch block. The MBB is a “diagnostic” procedure because by itself it is unlikely to deliver lasting facet joint pain relief. The purpose of the MBB is to determine how much pain can be attributed to the targeted facet joint(s) and to establish how many joints are involved. 

An intraarticular facet joint injection can provide the same diagnostic information as the MBB, but has the advantage of potentially providing longer term relief of pain symptoms if anti-inflammatory medication (a steroid) is also injected to interrupt the inflammation within the joint(s). 

Lumbar Radiofrequency Ablation (RFA) Neurotomy

If high quality BUT short term relief is experienced from either the MBB or the intraarticular facet joint injection, then strong evidence exists that facet joint pain is present. Most insurance companies require a second (confirmatory) MBB to also be successful before verifying a person’s candidacy for radiofrequency ablation (RFA) neurotomy.

RFA involves disconnecting (via heat lesion) the medial branches servicing the painful facet joints.  A comparison can be made to a common dental procedure, which deadens the nerve in an aching tooth when there is dental pain that can’t be resolved otherwise.  RFA is a nonsurgical option for facet joint pain if no other less aggressive treatment has provided relief. The results may not be permanent, however, due to the human body’s healing potential.

If the medial branch regrows enough to connect back to the facet joint, then the associated facet joint pain can return. If that occurs, then the RFA procedure can be repeated. It doesn’t mean that the RFA procedure has to be repeated frequently for the rest of your life, it just means that sometimes it may have to be repeated more than once.

How Is Lumbar Radiofrequency Ablation Neurotomy Performed

A moving x-ray machine called a fluoroscope is used to guide the entire procedure. The fluoroscope surrounds you like the letter “C” but it will never touch you. Nerves are “invisible” with x-rays so the fluoroscope is used to see the spine’s bone landmarks and increases the injection’s comfort, safety, and precision. The design of the C-arm fluoroscope allows visualization of the ideal view angle to perform your procedure. The fluoroscope delivers a radiation dose similar to an x-ray and the machine settings are adjusted to administer the absolute minimum radiation dose possible for your procedure.

The skin over the targeted landmark is injected with numbing medicine, which causes a very temporary sensation like a “bee sting”. The rest of the process feels like movement and pressure rather than pain.

The fluoroscope verifies each needle movement to ensure your safety and your comfort. Once the needle tip is in the ideal position relative to the bone landmarks, an important safety step is taken. The tip of the special RFA needle can send a stimulation to verify that the needle is not too close to the larger nerve root that travels into the corresponding leg, because the important goal of the procedure is to selectively disconnect only the small medial branch nerve and avoid injury to the larger nerve root. This important safety confirmation takes place before any deep numbing medication is injected and before the heat is generated at the tip of the special RFA needle. Once safety is confirmed, numbing medicine is injected at the needle tip followed by the heating protocol at the needle tip. After the heating is completed, then the needle is moved to the next targeted medial branch and the process is repeated. A bandage will be applied to the injection site and you be escorted back to the original exam room for after injection observation, monitoring, and discharge process.

Recovery After Lumbar Radiofrequency Ablation (RFA) Neurotomy

There is no need to restrict movements after this procedure, so activity can be as tolerated. The majority of patient feel relief within the first month after the procedure. For some it takes two months, and on rare occasions up to three months.

If you have facet joint pain from lumbar spine arthritis, then lumbar radiofrequency ablation (RFA) neurotomy may be the non-surgical solution that you’re looking for. Learn more at or call us today at (614) 999-9899 to find out if radiofrequency ablation neurotomy is the right option for your lumbar facet joint pain.  Contact the Regenerative Spine & Joint Center today to schedule an appointment.  

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I’m Boris Terebuh MD, Ohio’s first and most experienced Discseel® provider. I am also the Founder & Medical Director of the Regenerative Spine & Joint Center