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What is lumbar radiofrequency ablation (RFA)?
Lumbar RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to disrupt pain signals from the small nerves (medial branch nerves) that supply the facet joints in your lower back. It is commonly used to treat chronic low back pain caused by arthritis of the spine (facet joint pain) when other treatments like physical therapy or injections have not provided lasting relief.
Am I a candidate for lumbar RFA?
You are typically a candidate if:
- You have had significant (usually ≥70–80%) but temporary relief from diagnostic medial branch blocks or facet joint injections
- Your pain is primarily in the low back (with or without buttock/hip pain) and worsens with twisting, arching, or prolonged sitting/standing
- Imaging (MRI/X-ray) shows facet joint arthritis
- You’ve already tried conservative treatments (PT, medications, etc.)
How should i prepare for the procedure?
- Stop blood-thinning medications (aspirin, Plavix, Coumadin, Eliquis, etc.) as instructed (usually 5–10 days prior)
- Arrange for someone to drive you home (you cannot drive the day of the procedure if you are receiving sedation)
- Do not eat or drink after midnight the night before if IV sedation is planned
- Wear comfortable clothing and arrive 30–60 minutes early
How are the Procedures done?
You’ll lie face-down on an x-ray table. The skin is numbed with local anesthetic. Using live x-ray (fluoroscopy) guidance, the doctor places thin needles next to the targeted medial branch nerves. A small electrical current first confirms correct placement (you may feel tingling or muscle twitching in your neck/shoulders). The nerves are then heated to 80–90°C for 60–90 seconds each. The entire procedure usually takes 15–30 minutes.
How long does pain relief last?
On average, relief lasts 9–18 months (sometimes longer). When the nerves regenerate, pain can gradually return, but the procedure can be safely repeated if diagnostic blocks again confirm benefit.
Is the procedure painful?
Most patients feel pressure or a brief burning sensation when the local anesthetic is injected into the skin, but the procedure itself is generally well-tolerated. We can provide mild sedation (oral or IV) if you are very anxious.
What is the success rate?
When patients are carefully selected with positive diagnostic blocks, 70–90% of patients experience at least 50% pain reduction, and many get 80–100% relief for many months.
What is recovery like?
- You go home the same day (within 30–60 minutes after the procedure)
- Rest for the remainder of the day; most people return to work in 1–3 days
- Soreness or a sunburn-like feeling in the back for 1–4 weeks is normal
- You can usually resume physical therapy 2–4 weeks later
When will I notice pain relief?
Relief typically begins within 1–3 weeks and can last 9–18 months or longer. Nerves can eventually regrow, but the procedure can safely be repeated if pain returns.
Do I need a driver?
Yes. Sedation is commonly used, and if used an adult is required to take you home. Also with sedation you are to fast for 8 hours prior to the appointment.
Will I have any restrictions after the procedure?
- No driving or operating machinery for 24 hours
- No soaking baths or swimming for 48–72 hours
- Light activity the first few days; gradually resume normal activities as tolerated
- Avoid heavy lifting or strenuous neck motion for 1–2 weeks
What are the risks and side effects?
RFA is very safe, but possible risks include:
- Temporary soreness or bruising at needle sites
- Temporary numbness or tingling in the scalp, shoulders, or arms
- Rare infection, bleeding, or nerve injury
- Very rare risk of allergic reaction to local anesthetic Overall serious complication rate is <1 in 1,000 procedures.
Are there any contraindications?
Yes. The procedure is typically not performed if you have:
- Active infection or fever
- Bleeding disorder or taking blood thinners (some can be held)
- Uncontrolled diabetes or congestive heart failure
- Allergy to contrast dye or local anesthetics
- Pregnancy
