Cervical Medial Branch Radiofrequency Ablation

What is RFA Surgery?

Cervical medial branch radiofrequency ablation, or RFA, is a minimally invasive treatment to relieve neck pain. RFA utilizes radiofrequency waves that generate heat to destroy the nerve tissue that transmits pain from an arthritic joint. Only a small amount of current is needed on the targeted nerve. RFA technology is also used to blast tumors and stabilize irregular heart rhythms. We leverage this technology to alleviate neck pain, which is one of the most common conditions we treat.

What is RFA Used For?

The cervical section of the spine, which connects the skull to the torso, consists of seven vertebrae. Disks between the bones act as cushions. Facet joints, each about the size of your thumbnail, connect the bones. Soft tissue, fluid and a slippery coating of cartilage ensure ease of movement within the facet joint. Over time, cartilage within the facet joint breaks down and arthritis persists.

It may start to wear thin with age or get damaged during an acute injury like whiplash. Facet joints may swell resulting in pain and diminished mobility.  Bone spurs or facet arthrosis may develop in the affected area. Medial branch nerves, which pass through the facet joints, transmit pain signals telling your brain that something has gone wrong. People can live with aging or damaged joints, but ongoing pain is difficult to endure. If you have experienced symptoms for more than a couple of months, you’re an ideal candidate for RFA pain treatment.

Diagnosing RFA

Damaged facet joints do not always show up on traditional X-rays or MRIs. Diagnosing this problem is a matter of delivering pain relief to the suspected joint or joints. If the pain subsides, the doctor has correctly pinpointed the problem area and can target for treatment. This initial procedure is known as a cervical block or medial branch nerve block.

Guided by a special type of x-ray called fluoroscopy, the doctor stimulates medial branch nerves looking for a reaction. When a muscle twitches or the patient reports feeling pain, the doctor concentrates on that specific nerve or nerves and injects a local anesthesia. This effectively blocks the pain signal to the brain and provides temporary relief. However, RFA is a more effective long-term solution.

How Does RFA Work?

RFA destroys the nerve tissue that sends the pain signal. First, you will receive an IV for mild sedation making you comfortable during the procedure. This will keep you calm and comfortable but not fully put you to sleep. Your doctor might ask you to describe what you are feeling during the procedure. Relying on X-ray guidance, the doctor uses an insulated needle to deliver a tiny electrode near the problematic joint and nerve. A small radiofrequency current generates heat, killing the nerve tissue. The current only lasts for 60 – 90 seconds. There may be repeated injections if more than one joint is damaged but the procedure rarely takes more than 90 minutes.

Preparing for RFA

Your doctor will provide a list of instructions for post-procedure recovery. You will be receiving anesthesia and should arrange for a ride home after the RFA.  Do not eat or drink for at least eight hours prior to the procedure. Do not take aspirin or products that contain aspirin for at least 7 days prior to your appointment. Lower the risk of infection by showering with anti-bacterial soap before your RFA. If you have diabetes or using blood thinners, your doctor might provide additional instructions.

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What to Expect After RFA

RFA recovery is fast and serious complications are rare. Most patients experience complete pain relief within one to three weeks. Depending on the cause and location of the pain, relief lasts anywhere from six months to many years. When the destroyed nerves regenerate, the procedure can be repeated. You should not drive for a day or two following your RFA.

Take it easy during this time. You may temporarily experience pain similar to a sunburn and slight numbness in the treated area. The injection site may swell a bit and feel sore. Treat it with an ice pack every two hours for 15 minutes or so. Take warm showers rather than baths for a couple of days. Pain has probably prevented you from regular exercise. Get back in shape gradually and safely. Like other conditions we treat, neck pain can have a profound impact on quality of life. Cervical medial branch RFA is a safe, effective solution for neck pain.

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