Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

A radiofrequency neurotomy is a type of injection procedure used to treat facet joint pain or sacroiliac joint pain caused by arthritis or other degenerative changes, or from an injury.

In this procedure, a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating pain.

The terms radiofrequency ablation and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy.

There are two primary types of radiofrequency ablation:

  • A medial branch neurotomy (ablation) affects the nerves carrying pain from the facet joints
  • A lateral branch neurotomy (ablation) affects nerves that carry pain from the sacroiliac joints.

These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs, so a heat lesion poses little danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but loss of these nerves has not proved harmful.

Medial Branch/Lateral Branch Nerve Block

Before the radiofrequency ablation procedure, a lateral branch or medial branch nerve block will have already been performed to prove that the patient's pain is being transmitted by those nerves. The medial branch or lateral branch block acts as a test run before the neurotomy procedure.

Additionally, a sacroiliac joint injection, facet joint injection, or other treatment methods will usually already have been attempted.

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Radiofrequency Ablation Success Rates

Success rates vary, but typically about 30% to 50% of patients undergoing this procedure for low back pain will experience significant pain relief for as much as two years. Of the remaining low back pain patients, about 50% will get some pain relief for a shorter period.

Some patients do not experience any relief from pain as a result of this procedure.

Overall, success rates are greater in the cervical spine (neck) than in other areas.

As a general rule, if effective, the ablation will often provide pain relief lasting at least 9 to 14 months and sometimes for longer. After this period of time, however, the nerve will regenerate and the pain may return.

Joints Treated with Radiofrequency Ablation

Joint arthritis, degeneration, or injury can lead to spine pain and limited range of motion. The joints treated with radiofrequency ablation are:

  • Facet joints - pairs of small joints that are situated at each vertebral level in the back of the spine. Each facet joint is connected to 2 medial branch nerves that carry signals (including pain signals) away from the spine to the brain.
  • Sacroiliac joints - joints located at the lowest part of the spine, between the sacrum and ilium in the pelvis, and are connected to lateral branch nerves that carry signals to the brain.

The radiofrequency ablation procedure is designed to treat lower back pain originating from either facet joint or sacroiliac joint problems.

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Written by Ray M. Baker, MD