Radiofrequency ablation (RFA) was first used in 1931 to treat a case of trigeminal neuralgia (facial pain stemming from the trigeminal nerve). Before RFA, trigeminal neuralgia was complex and often considered untreatable. This treatment successfully treated this mysterious condition and has now become a go-to treatment for multiple pain conditions of the spine. If a radiofrequency ablation procedure is in your future, here’s what you need to know.
What is a radiofrequency ablation procedure?
Radiofrequency ablation uses a small electrical pulse to interrupt nerve signals to the brain. This small pulse heats the nerve, damaging it and causing signals to be disrupted. There are two kinds of radiofrequency ablation procedure – continuous and pulsed. As the names suggest, the first sends a steady electrical pulse, while the second can be programmed at intervals.
Why choose a radiofrequency ablation procedure?
The anatomy of the spine is a great place to start when deciding on a radiofrequency ablation procedure. The 24 vertebrae of the spine stack one upon the other, with fluid-filled discs cushioning them. These discs prevent painful bone-on-bone contact and allow the spine to move fluidly.
When injury or damage occurs to the discs, extreme debilitating pain can result. Spinal pain can also occur as a result of wear and tear on the spine over time. Some conditions that a radiofrequency ablation procedure can treat include:
- Arthritis pain
- Lumbar spine pain
- Cervical facet joint pain
- Trigeminal neuralgia
Often, patients will undergo a medial branch block before choosing a radiofrequency ablation procedure. The medial branch block can help more accurately identify which nerves are causing pain prior to radiofrequency ablation.
What to expect during a radiofrequency ablation procedure
From start to finish, the entire radiofrequency ablation procedure will take just a few hours. Patients can choose to have just a local anesthetic or light general anesthesia.
Patients will position themselves face down on the table. The doctor will clean and sterilize the area to be injected, apply a numbing cream, and then administer a local anesthetic.
When the patient is comfortable, the doctor will use fluoroscopy to guide a hollow needle towards the area for radiofrequency ablation. The doctor will then send a microelectrode through the needle to the nerve being targeted.
Once the microelectrode is placed, a test electrical pulse will be sent through the microelectrode to ensure proper placement. When the placement is correct, the doctor will deliver a numbing agent (and possibly a corticosteroid to minimize inflammation) before heating the electrode to damage the nerve.
After the radiofrequency ablation procedure, patients should avoid vigorous activity or heavy lifting for at least 48 hours afterwards. They should also not bathe for two days following the procedure. A gradual return to regular activity levels is advised.
Bandages should be changed daily or whenever they get wet to prevent infection.
Potential side effects of a radiofrequency ablation procedure
Radiofrequency ablation is considered a low-risk, minimally-invasive procedure with limited potential side effects. However, as with all procedures, there are some side effects that may occur. These include:
- Mild back pain unrelated to the condition being treated
- Bruising, swelling, or bleeding at the injection site
- Infection at the injection site
- Allergic reaction to any steroids (if used)
- Leg numbness or tingling
- Temporary increase in pain
The above side effects are considered mild and should disappear within a few days. If they persist after three days, a call to the pain management specialist may be in order.
There are a few signs of potentially serious side effects that warrant immediate medical attention. A fever over 100.4°F and drainage from the site of the injection can indicate a serious infection. In this case, the doctor should be called immediately.
In some cases, the first radiofrequency ablation procedure does not work. The wrong nerve may be targeted, or the nerve may not be completely damaged in order to disrupt pain signals. Nerves may also heal themselves, necessitating another radiofrequency ablation procedure in the future. This can be very discouraging for patients. In many cases, a second radiofrequency ablation procedure can help.
Risk factors for radiofrequency ablation procedures
Although side effects for a radiofrequency ablation procedure are generally mild, there are some risk factors that can cause more serious side effects or complications. These include:
- Previous, active infection (e.g., a cold or other viral infection)
- Diabetes that is not controlled
- Weighing over 250 pounds
- Long-term steroid use
- Issues with blood clotting
Each of these factors influence the body’s ability to heal itself as well as the stress that is currently active in the body. A person who is fighting an infection may have a hard time processing another procedure.
In general, the better the overall health of a patient, the better their chance for a successful radiofrequency ablation procedure.
Preparing for a radiofrequency ablation procedure
One of the best ways to prepare for a radiofrequency ablation procedure is to do some research on the procedure itself. Check out our site for more about information about RFA. The Mayo Clinic also has great educational guides, and your doctor may be a wealth of information too. Ask plenty of questions during your surgical consult. There are also videos of radiofrequency ablation if you think this might set your mind at ease.
Bring a friend or family member along with you to your procedure. They can drive you home and help to fill any prescriptions or gather supplies you may need. This is a minimally-invasive procedure, but you may feel a bit sore and sleepy afterwards. Having a friend to help you get home and settled can be very comforting.
Have you had a radiofrequency ablation procedure for your pain condition or would you consider it?