Lumbar Radiofrequency Ablation (RFA) for Chronic Lower Back Pain
A lumbar radiofrequency ablation (RFA) is an outpatient procedure for diagnosing and treating lower back and leg pain. It is also called lumbar facet thermal coagulation or rhizotomy. This information sheet will explain what it is. Your doctor can explain if it is for you.
Facet joints connect the vertebrae, the bones of the spine. They help guide your spine when you move. The lower back area of the spine is called the lumbar region. It contains five vertebrae. Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Lumbar facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right L4-5 facet joint, for example, joint the 4th and 5th vertebrae on the right side. Medial branch nerves are found near facet joints. They transmit pain signals from the facet joints to your brain. They tell the brain when a facet joint has been injured.
What is the lumbar facet joint pain?
You may feel pain if a lumbar facet joint is injured. Sometimes it feels like muscle tension. Other times it can be severe pain. The cartilage inside the joint may be injured. Other times only connecting ligaments surrounding the joint are injured. Facet pain also depends on which facet joint is affected. Lumbar facet pain can occur in an area from your lower back to your buttock.
If you have pain in one or more of these areas when you turn your lower back, and it lasts longer than two months, you may have lumbar facet pain. Common tests such as x-rays or MRIs may not always show if a facet joint is causing pain. The best way to diagnose facet pain is to block the pain signal in a medial branch nerve with a local anesthetic.
What is a lumbar RFA?
RFA uses radiofrequency energy to disrupt nerve function. When this is done to a lumbar medial branch nerve, the nerve can no longer transmit pain from an injured facet joint.
What happens during an RFA?
A local anesthetic will be used to numb your skin. The doctor will then insert a thin needle near the medial branch nerve. Fluoroscopy, a type of x-ray, may be used to ensure the safe and proper position of the needle. The doctor will then check to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching and provoke some of your pain. Once the doctor is sure the needle is correctly placed, the nerve will be numbed. Radiofrequency energy will then be used to disrupt the medial branch nerve. This is often repeated at more than one level of the spin.
You will be monitored for up to 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions. You will also be given a pain diary. It is important to fill this out because it helps your doctor know how the RFA is working. Take it easy for the rest of the day. You may feel sore for one to four days. It may be due to muscle and nerve irritation. Your lower back may feel numb, weak, or itchy for a couple weeks. Maximum pain relief normally comes in two to three weeks.
Nerves regenerate after an RFA, but how long this takes varies. Your pain may or may not return when the nerves regenerate. If it does another RFA can be done.
This is meant only for general information. For information specific to you and your pain please contact your doctor and he will be able to discuss this with you.
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