The spine’s joints are called facet joints or zygapophyseal joints. Facet joints are found in the cervical (neck), thoracic (mid back), and lumbar (low back) spine. These joints allow the spine to flex, extend, and rotate. The medial branch nerve innervates (stimulates) the facet joint. As we age, or secondary to trauma (such as whiplash), the facet joints can be damaged and develop arthritis similar to other body joints.
Facet joint pain can be secondary to back pain and may radiate (travel) into the hips, buttocks, and posterior thighs. While arthritis is commonly detected by x-ray or MRI, the presence of arthritis/facet hypertrophy (increased joint size) does not always mean it is the cause of low back pain.
The medial branch nerve innervates the facet joint and may cause nerve root irritation and pain. A medial branch nerve root block is performed to confirm that a facet joint is the source of your pain. While the nerve block is diagnostic, it may be therapeutic providing pain relief.
If the pain from the facet joints returns after a lumbar medial branch block, the first step is to repeat the procedure. If the patient gets pain relief again from the local anesthetic placed on the facet joint, but then again has a return of pain, the patient may be a candidate for the lumbar radiofrequency ablation for longer term relief.
The lumbar Radiofrequency Ablation, or RFA for short, is a percutaneous (through the skin) procedure in which the nerves for the facet joints are ablated (destroyed) using radiofrequency heat. The nerves are ‘burnt’ using heat generated through a radiofrequency generator, and special needles are used that have a tip that heats. These nerves are only responsible for the transmission of pain so there are usually no other negative effect from eliminating these nerves.
If the underlying cause of pain does not improve, the pain can potentially return in 6-9 months. At that time the decision can be made to repeat the procedure.
Before the RFA, you may be given medication to relax you (optional). Patients typically prefer to have some sedation for this procedure.
The skin area is numbed using a local anesthetic. Using fluoroscopy (real-time x-ray), the physician guides the RFA needle into the proper area of your spine. Once the needle is positioned near the median nerve, the radiofrequency generator is used to make sure that only the nerves that transmit pain are contacted. Once this is verified, local anesthetic is placed, and then the nerves destroyed with the special needles and heat.
To Learn More
If you are interested in an evaluation into the cause of your low back pain, or a radiofrequency ablation to manage your pain, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, Staten Island, Brooklyn, and Long Island New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.