What is RFA?
RFA is a procedure that uses radio frequency energy to heat and burn painful nerves so that they do not transmit pain, relieving the symptom. Concurrently, it can be used to burn away any inflammation within the facet joints, removing the source of pain. This treatment is commonly used for back pain.
Pain in the facet joints has been reported to cause up to 40% of lower-back pain. Facet joints are small joints behind the spinal discs which help to support the spine and allow it to move. If the facet joint is arthritic or inflamed, it can become painful, causing neck pain or low back pain, with or without pain in the legs.
Facet joints are susceptible to injuries and daily wear-and-tear. Trauma, such as whiplash injuries (a sudden jerk of the neck), twisting while lifting overhead, or unguarded rotation of the spine, may irritate the facet joint. These irritations may cause tears, inflammation and/or distortion of the joint. Wear-and-tear can cause loss of cartilage or degeneration of the spinal discs. The disc, which functions as a cushion, collapses, causing pain in that area.
How is RFA Performed?
RFA to burn off the inflammation is done under a local anaesthetic. Mild sedation may be used to reduce any discomfort during the procedure. RFA is delivered through a needle into the facet joints under X-ray guidance. You will be awake during this process, and you may be asked if you are able to feel a tingling sensation. This ensures the needle is in the right place. Once the needle and electrode placements are verified, a radio frequency current is sent to each facet joint and nerve for 90 seconds to heat and “burn” the nerve that transmits pain signals. Once the inflammation is gone, it can no longer send pain signals, resulting in lesser pain.
Who will Benefit from RFA?
RFA is suitable for treating pain arising from facet joints, such as arthritis of the neck, lower back and upper back, that has not been adequately relieved by medications or physical therapy.
RFA can be recommended after the patient is diagnosed with a positive nerve block. The test involves injecting a small amount of numbing medication. By blocking the nerve, the brain no longer receives the painful signals from the damaged facet joint and, therefore, a temporary pain relief is achieved. As the local anaesthetic effect wears off in 2-4 hours, the usual pain returns. If the block reduces the pain by at least 50% of the time, the block is considered positive, and RFA is usually recommended.
What is Recovery Like?
This is a day-surgery procedure. The patient can go home on the same day and, the next day, get back to work or to his/her daily activities. The patient will not need long duration of rest in bed.
Is the Pain Relief Permanent?
The benefit from RFA may last for more than 2 years in 80% of cases and about 6–8 months for the remaining 20%. RFA may be repeated in 6--8 months for those whose nerves regenerate after the procedure, or the particular facet joint gets inflamed again, and the similar pain returns.
It is important that the patient participates in regular rehabilitation and exercises after the procedure, to strengthen the core muscles supporting the spine and reduce the physical stress on the facet joints.
If the procedure only partially reduces the pain, the remaining pain usually comes from chronically damaged ligaments, joints or discs. Prolotherapy (an injection of concentrated hypertonic solution such as concentrated glucose into the ligaments) may be a helpful addition to strengthen ligaments/tendons and tighten the loosened/distorted joints. With this additional therapy, pain is relieved and the joints can function normally. Periodic injection with steroids may also significantly reduce chronic lower-back pain.
What are the Risks and Side Effects?
There are no risks of side effects to RFA treatment of facet joint pain. This is absolutely safe, without any risk of paralysis or nerve injury. Post procedure, there may be some numbness in that area of treatment. This may last 6 weeks to 2 months.