Focal Neck & Back Pain
Radiofrequency lesioning is a procedure in which sensory nerves are purposefully altered by a heated probe. This technique is usually performed for focal back or neck pain caused by degenerative facet joints. Facet joints are true synovial joints which connect the posterior spinal column. They are subject to degeneration and inflammation and become a very common cause of pain, especially in the elderly. Each facet joint is innervated by 2 sensory nerves and their location is predictable along the bony spine. A diagnostic block of each nerve with local anesthetic will determine if the presumed facet joint is the cause of pain. If the patient obtains pain relief after the diagnostic block, then the patient will return for the radiofrequency lesioning procedure.
The aim of radiofrequency lesioning is improved pain and function. The procedure is not permanent however with recent literature stating an average pain relief of 9 months and in some cases a longer period of time. As with any procedure, there are potential risks including: infection, bleeding, nerve injury, and worsened pain.
The procedure is performed at the outpatient surgery center. An IV (intravenous) line is started preoperatively in order to give the patient mild sedation. The patient is then brought to the procedure suite and placed in the prone (face down) position. The skin is cleansed with an antiseptic solution and drapes are placed to keep a sterile field. The physician uses an x-ray machine to visualize the spinal anatomy and intended targets. Next, the skin and subcutaneous tissues are anesthetized with a local anesthetic. A special needle is then inserted and placed next to the sensory nerve. Sensory and motor testing is then performed by a special machine which informs the physician of his proximity to the sensory nerve. When appropriate, the physician will give some local anesthetic prior to heating the needle. The lesioning (heating) process itself only takes 90 seconds.
After the procedure, there may be some slight discomfort from the process of needle insertion. Usually the procedure is very well tolerated and patients can resume their normal activities the next day. The full effect can take several days, so the patient may not perceive any immediate benefit. Radiofrequency lesioning can be repeated on an as needed basis.