What is a Radiofrequency Ablation?
Radiofrequency ablation is a treatment that targets the medial branch nerves that run along your facet joints. Before this procedure, you will have a medial branch block to ensure this treatment will work for you. If you had significant pain relief from your medial branch block, you would benefit from having a radiofrequency ablation or RFA.
Radiofrequency ablation treats chronic pain by using radio-frequency waves to burn your medial branch nerves. Over time, these nerves regenerate and return to their normal function. While your medial branch nerves are cauterized, you will be able to focus on rebuilding strength and joint function without feeling pain. Radiofrequency ablations can be applied to the same three areas as the medial branch block: cervical (your neck), thoracic (mid-back), and lumbar (lower spine).
How to Prepare for an RFA?
Your doctor will review your medical history and imaging. If you are taking aspirin, ibuprofen, or over the counter medications to reduce your pain, speak with your care provider about which ones you’ll need to discontinue for the procedure. NSAIDs (blood-thinners) such as ibuprofen and Aleve cannot be taken for four days prior to the procedure. Make arrangements to have someone drive, as you will not be able to drive for 24 hours after the procedure. Additionally, you cannot take public transportation and must have a responsible adult with you.
What Happens Prior to an RFA Procedure?
You will receive paperwork prior to the operation, which will include consent forms, and ask for current medications, and allergies. The actual procedure may last 15-45 minutes followed by a monitoring period.
With an RFA, you can have IV sedation or Valium prior to the procedure. If you opt for IV sedation you must fast from food for 6 hours prior to your appointment and fast from water 2 hours prior. After taking your vitals, the medical assistant will insert the IV and then escort you back to the procedure room. If you opt to have Valium, you will need to arrive at least 30 minutes prior to your appointment to allow the medicine to take effect. You can also opt to have the procedure without sedatives.
Regardless of your sedation option, you will lie down on an x-ray table. If you are having a cervical RFA you may need to lie on your side. Otherwise, you’ll lay face down. Your shirt will be taped to allow access to the specific area of your back. The medical assistant will prep the injection area by using a soapy sponge to clean your skin. If you have IV sedation, the assistant will inject the sedatives into your IV. This sedation will not result in unconsciousness but will keep you from feeling the pain.
The RFA Procedure
The doctor will come in and begin the procedure by using a fluoroscope to view the injection site. This fluoroscope allows them to see the hollow needles used for the injection in real-time. Once inserted, the hollow needles will administer contrast dye, to verify that the needles are in the proper location. If the needles are in the correct place, your doctor will inject a numbing medication. Then a probe emitting radiofrequency waves will be inserted into the needles and heated to create a small precise burn on your medial branch nerves. The doctor will then remove the needles and sterilize the injection site.
Following the procedure, you will have a few minutes to rest, and then the nurse will put you in a wheelchair. You’ll remain in a monitoring area until you feel well enough to return home.
What to Expect for Recovery After an RFA?
Most patients can walk without difficulty after the procedure, you shouldn’t have any issue walking to your vehicle. If you have a cervical RFA, you may have some temporary changes in balance. Make sure you have someone nearby to support you if you need to move around.
Once you have left the establishment, you should continue your regular diet and medications. Do not drive or operate machinery for at least 24 hours after the procedure. Additionally, you’ll need to take it easy for the next day or two. After this period of rest, you can return to your normal activities. You can return to work 24-72 hours after your procedure depending on your pain levels. Most patients experience pain relief within the first 10 days, however, it may take up to three weeks for some individuals. Furthermore, you should schedule a follow-up appointment with your physician 4 weeks after your procedure.
What Results Can I Expect From an RFA?
Pain relief may last from 9 months to 2+ years. Over time, your nerves will grow back, however, your body will have healed from your injuries and your pain may not return after the regrowth. If your pain returns, an RFA may be repeated after 6 months.
What Are the Risks?
Radiofrequency nerve ablation has a minimal risk of complications. The risks include temporarily increased nerve pain, neuritis (inflammation of the nerve), neuroma (pinched nerve), numbness, infection or allergic reaction, and the potential for a lack of pain relief.
Who Shouldn’t Have an RFA?
RFA should NOT be performed on people who are pregnant, have infections, or have bleeding problems. Do not take blood thinner medications such as Aspirin or Excedrin. If you are taking any blood thinner prescriptions, make sure you talk with your doctor before discontinuing the use of these medications.
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