Purpose of the Procedure:
Medial branch RFA is a minimally invasive procedure designed to reduce chronic neck or back pain stemming from facet joints. It works by disrupting the medial branch nerves that send pain signals from these joints to the brain.
Before the Procedure
- No Fasting Required: You may eat and drink normally unless otherwise instructed.
- Medications: Continue your regular medications unless directed otherwise by your doctor.
- Transportation: Arrange for someone to drive you home. You should not drive or operate heavy machinery for the rest of the day.
Day of the Procedure
- Location: The procedure is done in a medical clinic or hospital setting, often under fluoroscopic (X-ray) guidance.
- Preparation: The skin over your spine will be cleaned in a sterile fashion.
- Positioning: You’ll lie face down on a procedure table.
- Procedure Time: The procedure usually takes 30 to 45 minutes, depending on the number of levels treated.
During the Procedure
- A thin needle is inserted near the targeted medial branch nerve(s)
- A small amount of electrical stimulation is done to confirm proper positioning
- The nerve is then heated using radiofrequency energy to disrupt pain signals.
After the Procedure
- Observation: You’ll be monitored briefly before going home.
- Mild Discomfort: Some patients experience temporary soreness or increased pain for a few days up to a week (sometimes longer if you have a lot of sensitization)
- Activity: Light activity is encouraged. Avoid strenuous activity for 24-48 hours.
- You can apply ice packs (20 minutes on and 20 minutes off) and take Tylenol or Advil. Sometimes a stronger painkiller will be prescribed.
- Depending on your occupation you may need a few days off work. Please discuss this with your doctor prior to the procedure.
- You can resume driving when you feel ready although have to wait at least 24 hours if sedation was used.
Expected Results
- Onset of Relief: Pain relief is not immediate. It typically begins within 1 to 3 weeks, once the nerve has fully ablated and inflammation settles.
- Duration of Relief: Pain relief can last 6 to 18 months, depending on the individual and the underlying condition.
- It is very important that you continue to perform regular exercise including stretching, strengthening, and aerobic exercise during the period of reduced pain. Patients who exercise regularly will have a longer duration benefit and are less likely to have their pain recur. Patients who do not exercise may notice that the procedure becomes less effective over time or it may stop working entirely.
- Repeatability: The procedure can be repeated if pain returns.
When to Call Your Doctor
Call your doctor if you experience:
- Fever over 38°C (100.4°F)
- Increasing redness, swelling, or discharge at the injection site
- New or worsening weakness
What are the risks?
Risks associated with any injection include: infection at the site of the injection, increased inflammation and pain at the site of the injection, bleeding, bruising, injury to blood vessels or nerves, and allergic reaction to the local anesthetic or other medications used during the procedure. There may be other specific risks depending on the location of the injection.
Negative side effects of RFN include 1-2 weeks of aggravated pain due to local tissue trauma and numbness in the sensory distribution of the nerve. RFN can cause a small area of skin irritation or numbness that can persist for several months (called neuralgia or neuritis). Patients have described this sensation as similar to sunburn, itch, or a sensation like something is touching their skin in that area. It is usually mild but severe reactions have been known to occur. It can usually be treated with a topical local anesthetic cream.
Will the absence of sensation cause me to injure the area more?
Generally speaking no. If you have an area of numbness on your skin after the procedure then this area is at risk of being injured by excessive application of heat or cold. Additionally, you may not be able to feel a cut or object rubbing the area. It is important that you inspect any areas of numbness, particularly on the feet or hands, on a regular basis to ensure that skin injuries have not occurred.