Radiofrequency Ablation of Lateral Branch Nerves
This is a nonsurgical intervention meant to help relieve pain and improve function for those with pain confirmed to be from the sacroiliac joints. This treatment sometimes is referred to by other names such as RFA, rhizotomy, radiofrequency neurotomy, radiofrequency thermocoagulation to name a few. Typically these are done after confirmation of the pain generator by lateral branch nerve blocks (usually two). If the diagnostic blocks were positive (meaning there was immediate and significant pain relief after the block) then the RFA would be the next step. If the blocks were negative (meaning no relief at all or minor relief) then the ablation would not be recommended.
What is an ablation and what is being ablated?
The word ablation means removal or destruction of body tissue. In this case the tissue being destroyed are lateral branch nerves (more on this in a little bit). The way these nerves are destroyed (ablated) is by heat generated by radiofrequency waves transmitted by wires inserted through a cannula (type of hollow needle) tip . The tip delivers the heat which ablates the targeted nerves. The targeted nerves are lateral branch nerves which innervate (transmit sensation) sacroiliac joints. These joints can develop arthritis, dysfunction and pain which can result in lower back pain typically felt at or below the belt line. Ablating the lateral branch nerves will stop the transmission of pain from the sacroiliac joints therefore stopping the sensation of pain.
What it does
By destroying the lateral branch nerves connected to the sacroiliac joints the RFA treatment helps treat chronic lower back pain originating from the sacroiliac joint. The relief of pain can be complete relief or partial relief depending on the outcome and can last anywhere from 6 to 12 months in duration. The reason that the response is temporary is because with time the lateral branch nerves will regrow and reconnect. When the pain comes back, this procedure can be repeated.
What it doesn’t do
The RFA treatment does not heal, treat, or reverse arthritis or any injury to the sacroiliac joints. The only benefit is reducing and eliminating chronic constant pain. In that sense the RFA does not “fix the problem” nor has any way of preventing pain from returning in the future. They are strictly meant for alleviating pain from the sacroiliac joints. Pain relief is usually 6-12 months in duration.
Then why do it?
Recommended when sacroiliac back pain is chronic, constant, severe and not responding to conservative treatment efforts such as physical therapy, exercise, medications, bracing, topicals, acupuncture, etc. Also recommended as an alternative to surgery when surgery is either not preferred, not indicated, too risky, or has already been tried.
What are the risks?
Overall considered safe when performed with fluoroscopic (xray) guidance by a physician specialized in interventional pain management. Preferably one who is board certified and fellowship trained. Risks are similar to other spine interventions and include infection, bleeding, allergic reaction, pain aggravation, nerve injury, and paralysis (rare). An additional risk with RFA is a complication called post RFA neuritis. This can present with sensations of numbness/tingling, sensitivity to touch, and feels like a sunburn. This is usually a very temporary complication and improves with time and without treatment.
