What is it?
Radiofrequency lesioning is a minimally-invasive procedure where high-frequency radio waves are passed through a needle into a small area of a patient’s nerve. When this happens, it creates heat and damages the nerve. This also blocks pain signals to the brain, which can help eliminate or reduce pain.
Sedation and a local anesthetic is given. The physician will use fluoroscopy (a specialized x-ray) to guide the needles. Electrical stimulation is performed before any lesioning. This may produce a buzzing or tingling sensation. You may also feel your muscles jump. You will be allowed to awaken during this time in order to pinpoint the areas to be lesioned. Electrical current is then used to disrupt the affected nerves.
In many cases, surgery can be avoided when it is used. Although every patient’s condition is unique, patients who have chronic neck and back pain can often benefit from the procedure depending on the diagnosis.
The procedure is specifically for pain emanating from facet joints. These joints are located along the entire spine on each side of the midline. Unfortunately, most other types of pain cannot be successfully treated with this form of therapy.
A variant of radiofrequency lesioning called “Pulsed RF” has been utilized to treat some other types of pain. Instead of a heat lesion, it applies an electromagnetic impulse to adjacent nerves. However, Pulsed RF is considered experimental and therefore not covered under most insurance plans, including Medicare. The reported pain relief is typically less dramatic and lasts for only 2-3 months.
What are the expected results?
Pain relief from this procedure lasts until the nerves regenerate, which is typically 9 months but can range from six months to two years. Patients are typically sore for a few days after the procedure, although responses can vary. Pain relief is typically experienced within 1-2 weeks after the procedure.
Preparing for the Radiofrequency Lesioning
Before scheduling the procedure, a physician will need to perform a diagnostic test to identify the source of pain. To do this, the physician will place a temporary block on select nerves using only a local anesthetic. By doing this, they can confirm the pain is being transmitted by those nerves.
What Happens During Radiofrequency Lesioning?
The patient is sometimes given a light sedative. This is often needed because only a small amount of local anesthetic can be used at the beginning of the procedure. This is because the nerves have to be located and tested in real-time. The local anesthetic would interrupt this testing. The sedative helps to relax the patient and tolerate any minor discomfort that might occur.
Once the correct nerves are located and testing is successful, a radio wave will be used to produce thermal energy that will interrupt the nerve’s ability to send an effective pain signal.
After the sedative wears off, the patient can go home. Most patients are discharged the same day as the procedure. Because of the sedation, patients will need to have a friend or family member drive them home after the procedure.
The procedure itself typically takes 30-60 minutes to perform. You will be observed in the recovery room for 30-60 minutes after the procedure.
It can take 1 to 4 weeks to for the block to work. Often patients experience pain relief after radiofrequency denervation that lasts from six months up to two years. After two years, since nerves regenerate, patients may need to schedule a repeat procedure.
What to expect the day of your procedure?
You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you will be receiving medications that could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand. Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you. Be sure to discontinue aspirin products and any other blood thinners as instructed.
After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.
You may be asked to change into a gown. An assistant will take your vital signs and an IV may be started in order to provide pain relief and relaxation.
The physician and nurse will talk to you before your procedure. In certain cases, an anesthesiologist may also be utilized. You will then be positioned and the injection sites will be prepped. Your pain management physician will perform the procedure. Medications are typically administered before and during your procedure to help you relax and provide pain relief. You may doze off during this time. Afterward, bandages will be applied as needed.
You will be transported to the recovery room area where you will be monitored anywhere from 30 minutes to an hour. You will be offered beverages and some crackers. After this, someone will take out your IV and help you get dressed if needed. Lastly, your caregiver will be given discharge instructions for your care at home.