For Chronic Neck Pain and Headaches
Cervical radiofrequency ablation (RFA) is a common outpatient procedure used to treat pain in the neck, shoulder, and upper back. This procedure is often also called cervical facet thermal coagulation or rhizotomy.
Facet joints connect the bones in your spine called vertebrae. They help to guide your spine whenever you move. The cervical region is the neck area of the spine, which contains seven vertebrae. The facet joints, each about the size of a thumbnail, are located on both sides of the spine.
Cervical facet joints are named according to the vertebrae they connect and the side of the spine that they sit on. For example, the right C2-3 facet joint joins the second and third vertebrae on the right side of the spine.
Medial branch nerves are found near the facet joints, and they’re responsible for transmitting pain signals from the facet joints to your brain. These nerves tell the brain when a facet joint has been injured.
If a cervical facet joint is injured, it may cause you pain. This pain can be mild, like everyday muscle tension, or more severe. The injuries that cause cervical facet joint pain can occur in two places: the cartilage inside of the joint or the connecting ligaments surrounding the joint.
Depending on which facet joints are affected, pain can occur anywhere from your head to your lower shoulder blades.
Common tests like x-rays and MRIs don’t always show if a facet joint is causing your pain, which is why we enlist the help of alternative diagnostic measures when we need to.
The best way to diagnose facet pain is to numb the pain signal in a medial branch nerve with a local anesthetic. This will help your doctor find the injured area if an x-ray or MRI is insufficient.
RFA uses radiofrequency energy to disrupt nerve function. When a cervical medial branch nerve is disrupted, the nerve can no longer transmit pain from an injured facet joint to the brain.
First, a local anesthetic will be used to numb your skin. Once you are numb, your doctor will insert a small needle into the area near the facet joint. In order to get the positioning of the needle exactly right, your doctor will use a fluoroscopy (a type of x-ray) to get a better look. Your doctor will also check to make sure the needle is in the correct nerve by stimulating it. This process may cause muscle twitches and temporarily provoke some of your pain.
However, once the needle is properly placed, the nerve will be completely numbed. Radiofrequency energy will then be used to disrupt the medial branch’s nerve transmissions. This is often repeated at more than one level of the spine to ensure each pain point is addressed.
You may be monitored for up to 30 minutes after the RFA before you’re cleared to leave. After that point, our staff will provide you with discharge instructions and a pain diary. The pain diary is used to track your progress and determine how effective the RFA has been, so it’s important to use it. Be cautious in your movements for the remainder of the day.
You may feel sore for up to four days after your RFA. This soreness is caused by muscle and nerve irritation. Your neck may feel numb, weak, or itchy for a few days or even a couple of weeks. Maximum pain relief usually presents itself around two to three weeks after your RFA, but it can take as long as six to eight weeks in some cases.
Nerves can regenerate after an RFA, so the extent and duration of pain relief can vary between patients. Your pain may or may not return when the nerves regenerate. If your pain returns, another RFA can be performed.