What is a facet joint (medial branch nerve) radiofrequency ablation?

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The facet joints, like other joints in the body, form a working motion unit that allows movement between two vertebrae. The term “cervical” refers to the neck area, “thoracic” refers to the mid-back area, and “lumbar” refers to the lower part of the back. Similar to the shoulder or knee joints, lumbar facet joints are surrounded by a capsule that bathes the moving parts in lubricating fluid. 

 

When a facet joint is injured, pain signals from the facet joints travel along sensory nerves called the medial branches to the spinal cord and then to the brain. The injury may involve the cartilage (slippery covering of the ends of bones), the capsule, or the ligaments that surround the joint and connect it to the other parts of the spine. Additionally, the joint injury and pain may also cause muscle spasms through a natural “reflex action.” The location of the pain depends upon which the facet joint has been injured. 

 

Facet joint pain can be hard to see on X-rays or MRI (magnetic resonance imaging) tests. Before a radiofrequency ablation (lumbar RFA) is considered, your doctor will perform a clinical exam and perform two diagnostic procedures to temporarily block the medial branch nerve to identify the source of pain.

 

An RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with an X-ray to the correct site overlying the medial branch nerve.

 

Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure, or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety!

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How do I prepare for the procedure?

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No solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before arriving. If you are taking any blood thinners such as Coumadin, Xarelto, Eliquis, Plavix, or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make your Pain Management doctor aware that you are taking a blood thinner and contact your primary care physician or prescribing physician before stopping this medication.

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What are the risks of the procedure?

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As with most procedures, there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Other short-term side effects may occur. If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for several hours. If this happens, you may have to be observed until it resolves. You may have increased pain for a few days after the injections, including localized pain at the injection site.

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How much will the injection hurt?

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Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure (this lasts only a few seconds); however, each person’s response to any procedure will differ.

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What happens during the actual procedure?

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The procedure will be done in the fluoroscopy (X-ray) room with you lying on your stomach. An intravenous (IV) line may be started in your hand or arm to give fluids and/or medication to help you to relax. Your neck or back will be thoroughly cleansed with an antiseptic soap. Sterile drapes will be placed over your lower back. Your back will be numbed with injections of local anesthetic using a very small needle. You may feel a brief stinging or burning sensation, which will go away in about 15 seconds. Using X-ray guidance, longer needles are then advanced into the facet joints along the spine. Once the needles are in the proper location, the doctor will ask you if you feel a tingling sensation or if you feel your muscle twitching. This will help ensure the electrode is in the proper place.  Once the needle and electrode are in the correct location, a local anesthetic medication (with or without steroids) will be injected.  After the area is numbed, the nerve is heated with radio waves until that nerve is unable to pass pain signals to the brain. Once the needles are removed, your skin will be cleaned again, and Band-Aids will be applied. You will be moved to the recovery area, where your vital signs will be monitored for an appropriate time, usually about 20-30 minutes. You will be given verbal and written discharge instructions, and you will be able to leave with your driver after your doctor authorizes discharge.

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How will I feel after the injection?

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Your back pain may be improved immediately after the injection as a result of the local anesthetic.  We encourage you to move around and do your usual activities, provided they are not too strenuous.  Some local tenderness may be experienced for a couple of weeks after the procedure as you heal. Using an ice pack three or four times a day may help alleviate this.

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Will I have any restrictions on the day of the procedure?

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You may not drive for the remainder of the day after your procedure. A responsible adult (over 18 years old) must be present to drive you home or to go with you in a taxi. The procedure will be canceled if you don't have a responsible adult with you! This is for your safety. No heat is to be used on the injected area for the remainder of the day. No tub bath, shower or soaking in water (i.e., pool, hot tub, etc.) for the remainder of the day. You may resume normal diet and medications after the procedure unless told otherwise by your doctor.

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When Should I Call the Pain Management Center?

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We would like to see you in follow up 2 weeks after the procedure. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain score, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call our office immediately at 702-982-1300.