What Is a Radiofrequency Ablation?

A radiofrequency ablation (RFA) is a minimally invasive procedure used to treat chronic neck or low back pain that comes from the facet joints, the small stabilizing joints in the back of the spine.

RFA works by using controlled heat generated from radiofrequency energy to interrupt tiny sensory nerves called medial branch nerves. These nerves carry pain signals from arthritic or inflamed facet joints to the brain. By disrupting those signals, RFA can significantly reduce pain while preserving normal muscle strength and movement.

It does not remove arthritis. It does not involve major surgery. Instead, it reduces the nerve’s ability to transmit pain.

Longer-lasting relief for facet joint–related neck or low back pain:

Radiofrequency ablation (RFA), sometimes called radiofrequency neurotomy, is a minimally invasive procedure used to reduce chronic neck or low back pain coming from the facet joints (the small joints in the back of the spine). RFA works by using controlled heat to interrupt pain signals carried by tiny nerves called the medial branch nerves. The goal isn’t to “fix” arthritis, but to turn down the pain volume so you can move better, sleep better, and get back to doing the things your spine has been vetoing.

RFA is typically considered after you’ve had significant temporary relief from one or two medial branch blocks (diagnostic numbing injections). If those blocks reliably reduce your pain, it’s a strong clue that RFA may provide longer-lasting relief, often for months, sometimes longer, because it treats the same target nerves more durably.

Who is a good candidate?

You may be a good fit for cervical (neck) or lumbar (low back) RFA if you have:

• Persistent neck or low back pain that has lasted weeks to months, often with stiffness

• Pain that is worse with extension (leaning back), twisting, or prolonged standing

• Imaging showing facet arthritis may help, but the best predictor is your response to medial branch blocks

• Pain that is primarily axial (centered in the neck/back), sometimes with referral into the shoulder/upper back or buttock, rather than classic nerve-root pain down an arm/leg

RFA is not typically the first choice for pain driven mainly by a disc herniation with strong radiating symptoms, significant progressive neurologic weakness, or certain unstable spine conditions (your physician will review this with you).

Cervical vs. Lumbar RFA: what’s the difference?

The concept is the same, treat facet-related pain by targeting medial branch nerves, but the regions differ:

Cervical RFA (neck):

Often used for pain related to:

• Cervical facet arthritis

• Whiplash-associated facet pain

• Chronic neck pain with referral into the upper back/shoulder region
  Some patients also have associated headaches that can overlap with upper cervical facet-related pain (case-by-case).

Lumbar RFA (low back):

Often used for pain related to:

• Lumbar facet arthritis

• Mechanical low back pain worsened by standing/walking

• Pain after prior back injury or degenerative changes
  It can also help some patients with post-surgical facet pain, depending on anatomy and prior procedures.

What happens during the procedure?

RFA is typically done in a procedure suite using x-ray guidance (fluoroscopy) to ensure precise placement.

Step-by-step:

1. Positioning & numbing: You’ll lie on your stomach. The skin is cleaned and numbed with local anesthetic.

2. Targeting the nerves: A specialized needle is guided to the correct bony landmarks near the medial branch nerves.

3. Safety testing: We often perform gentle stimulation testing to confirm we’re at the right spot and away from motor nerves.

4. Radiofrequency treatment: The tip of the needle delivers controlled heat for a short period to disrupt the pain signal pathway.

5. Bandage & recovery: You’ll be monitored briefly, then discharged with instructions.

Most patients go home the same day. Many people return to light activity within 24–72 hours, depending on soreness.

Does it hurt? Will I be asleep?

Most patients tolerate RFA well with local anesthetic, and sometimes light sedation may be used depending on your needs, medical history, and facility protocol. You may feel pressure or brief discomfort during portions of the procedure, but the goal is to keep you comfortable while still being able to communicate.

When will I feel relief, and how long does it last?

RFA doesn’t always work instantly. Typical timeline:

• First few days: soreness is common at the treatment sites (like a deep bruise or sunburn sensation)

• 1–3 weeks: gradual improvement as post-procedure irritation calms down

• 3–6+ weeks: many patients hit their “true” benefit window

Relief duration varies. A common range is 6–12 months, sometimes longer. The targeted nerves can slowly regenerate over time, and symptoms may return. If you had good benefit, RFA can often be repeated.

Benefits of RFA:

• Can provide longer-lasting pain relief than steroid or numbing injections for facet pain

• Helps reduce pain enough to improve function, sleep, and activity tolerance

• May reduce reliance on daily medications

• Minimally invasive, outpatient, typically quick recovery

Risks and side effects:

RFA is generally safe, but like any procedure it has risks. These may include:

• Temporary increased pain or muscle spasm

• Local bruising, bleeding, or infection (rare)

• Numbness or tingling in the area (usually temporary)

• Neuritis (nerve irritation) causing burning sensitivity for a short time

• Allergic reaction (rare)

• Very uncommon risk of injury to nearby structures (minimized by imaging and technique)

Your physician will review your specific risk profile, including medication considerations like blood thinners.

How to prepare:

You’ll receive specific instructions, but common guidelines include:

• Bring a list of medications and allergies

• Ask us about blood thinners or aspirin before the procedure

• Arrange a driver if sedation is planned

• Wear comfortable clothing and plan for a lighter day afterward

Aftercare and recovery:

• Expect some soreness for several days; ice and gentle movement often help

• Avoid strenuous activity for 24–48 hours unless instructed otherwise

• Resume walking and light activity as tolerated, movement usually helps recovery

• Track your symptoms over the next few weeks so we can measure results accurately

Frequently asked questions:

Do you “burn the nerve”?
In plain English: we use controlled heat to interrupt the small pain-signal nerve fibers that serve the facet joints. The nerve typically regenerates over time.

Will this weaken my muscles or affect movement?
RFA targets sensory nerves to the facet joints, not the main motor nerves that power your arms/legs. We also use testing and imaging to improve safety.

Do I still need physical therapy afterward?
Often yes, RFA can reduce pain enough to make PT more effective. Think of it as clearing the runway so rehab can actually take off.

What if I didn’t respond to medial branch blocks?
If blocks didn’t help, RFA is less likely to help. In that case, we’ll reassess other pain generators and treatment options.

Reference:

Available at Hospital for Special Surgery: “Radiofrequency Ablation for Facet Joint Pain.”