Lumbar Radiofrequency Ablation (RFA) for Facet-Mediated Low-Back Pain

Lumbar radiofrequency ablation is a treatment for selected patients with chronic axial low-back pain arising from the lumbar facet joints. It targets the medial branch nerves that carry pain signals from those joints.

Lumbar RFA is not intended to treat every cause of back pain. Radiculopathy, sciatica, disc herniation, spinal stenosis, sacroiliac pain, and other conditions may require a different treatment pathway.

The MBB → RFA Pathway

Because examination and imaging alone cannot reliably prove that a facet joint is the pain generator, diagnostic lumbar medial branch blocks (MBB) are typically performed first. A local anesthetic is placed near the relevant medial branch nerves, and the patient’s temporary pain response is measured. Depending on the clinical situation and insurance requirements, confirmatory testing may be required before RFA.

If the diagnostic response supports facet-mediated pain, a radiofrequency cannula is positioned under fluoroscopic guidance near the target medial branch nerve. After appropriate testing and local anesthesia, controlled radiofrequency energy is applied to create a small thermal lesion intended to interrupt pain transmission from the facet joint.

What to Expect

RFA is performed on an outpatient basis. Temporary soreness, muscle spasm, or an increase in pain can occur after the procedure. Pain relief is not always immediate and may develop over days to several weeks. When RFA is effective, benefit may last for months, but duration varies.

Potential Risks

Risks can include bleeding, infection, temporary numbness or neuritis, localized pain, injury to nearby structures, medication reaction, incomplete pain relief, and rarely neurologic injury. Your physician will review risks that apply to your individual case.

Dr. David Nwokeabia is board-certified in Anesthesiology and Pain Medicine and performs image-guided interventional pain procedures at Solutions in Pain in Allen and Wylie, Texas.

a therapeutic radiofrequency procedure

Chloraprep will then be used to clean the procedural site & surrounding skin to help decrease chances of infection. The procedure site will then be identified under fluoroscopic guidance. Once the site is appropriately identified an injection of a numbing medication called lidocaine will be administered to numb the procedural site & surrounding skin. Once the lidocaine has settled the facet joint targets will be injected with a cocktail consisting of anesthetic (bupivacaine) and steroid (kenalog). This cocktail disperses and bathes the facet joints allowing targeted medication delivery for the following radiofrequency ablation. Before moving forward with the radiofrequency ablation we perform a trial of motor nerve tests to assure the targeted nerve is sensory and not compromising any motor nerves and their function. After we complete this clinical assessment and have allowed the medications to settle in we will proceed with radiofrequency ablation. Following procedure you will then be assessed and observed for an additional 5-10 minutes following completion of the procedure to ensure your safety and then scheduled for the next RFA as this is a bilateral procedure after which we will schedule post-procedural follow up at 10 days.

What To Expect After Procedure
● Substantial reduction in lower back pain
● Pain relief ranging from days to as long as 3-12 months or greater
● Acute short term mild swelling or pain around the injection site

Risks Associated With Lumbar Radiofrequency Ablation (RFA)
● Misplacement of the needle
● Unexpected bleeding
● Drug allergies
● Infection
● Nerve damage
● Worsening pain