Radiofrequency neurotomy (RFN) is a simple pain relieving minor surgical procedure. It is a procedure carried out under strict x-ray control using a fine needle called an electrode with local anaesthetic to place the tip of the electrode alongside a relevant small nerve. The needle tip is then heated to 85°C and “cooks” the nerve, thus rendering it dysfunctional. This does not destroy the nerve but prevents the nerve from functioning and thereby pain messages are stopped until the treated nerves regrow. This can take from three to eighteen months depending on the size and length of the relevant nerve.
The procedure is carried out as a simple day-only procedure in a hospital or appropriate facility such as the Clinic. Local anaesthetic I used with or without light sedation if needed.
It is a procedure that has been scientifically proven to be a safe and effective means of useful pain relief for many patients around the world.
Who is eligible for RFN?
Patients who have persistent, severe, disabling pain for which other simpler treatments have been ineffective and for which they would like a more effective treatment are eligible. They will have an adequately diagnosed condition, such as painful spinal zygapophysial joints (by means of diagnostic nerve blocks where they have had definite or complete relief repeatedly), nerve scars or nerve entrapment.
What are the treatment alternatives?
For a proven zygapophysial joint problem there is no alternative as effective for pain relief. However, many people find benefit in medications, exercises, manipulation or mobilization, physiotherapy techniques, pain management psychology, osteopathy, chiropractic, acupuncture, massage and other forms of treatment. Using one of these approaches may be all that you need to feel comfortable with your pain.
What are the risks?
- Small risk of infection or allergic reaction to local anaesthetic.
- There may be significant post-operative localised pain lasting two days to two weeks and which may feel like a deep bruise, similar to a severe thumping in the neck or back, but this is easily managed with analgesics and ice packs and gentle exercise.
- Risk of developing an area of hypersensitive ‘sunburn’ skin for days or weeks. This can range from a minor nuisance to a burning hypersensitivity which can be quite disabling but these can be made manageable with medications, repeat injection and ointments.
- There is a potential risk of damaging other tissues such as bone lining, ligaments, joint capsules and other tissues and this is why the pain can be significant for some time. It is also feasible to inadvertently damage other nerves if inadequate visualisation with x-ray has not been obtained. However, this is unlikely to occur with the use of x-ray visualisation and you remain awake throughout the procedure and may warn of inadvertent needle position.
- There is further radiation exposure which may be equivalent to the background radiation exposure of several return trips to Europe.
- There may be a few hours or days of dizziness and/or unsteadiness, particularly if the upper cervical joint is treated.
- The procedure may fail in as many as 30 percent of patients, often for technical reasons. A repeat attempt may be warranted should the latter occur.
- Eventual failure of the procedure. It is not known how many times radio frequency can be successfully repeated; some individuals have had ten to twelve successful repetitions.
What are the benefits?
There is a better than 70% likelihood of obtaining relief similar to that found during the diagnostic procedures. The duration of responses has varied from three months to eighteen months with an average of seven months.
A good result will allow the patient to reduce or cease medications and therapy and increase their ability to undertake a wider range of activities.
Can RF be repeated?
Yes. If other measures are insufficient to control otherwise unrelievable pain and the patient reports sufficient benefit from the previous procedures, this procedure can be repeated successfully in most patients.
However, if the first procedure is ineffective, that is if it does not work at all, then a repeat attempt has not yet been shown to be successful. However, if pain relief is incomplete or of short duration such as days or weeks then there is a 30-50 percent chance of a repeat procedure being more successful.
Following the procedure
You will be discharged from hospital or the Clinic when you are ready. You are advised to have transport arranged– it is not appropriate that you drive. If you have had sedation then you cannot drive or sign legal documents for 24 hours. However, most people can travel by car or plane several hours after the procedure.
The patient will be supplied a prescription for strong analgesics, and it is recommended that you use ice packs, and to lightly exercise your spine to prevent secondary tightness which can then cause further pain.
The patient is instructed to be followed up by your treating general practitioner and/or referring specialist. If Dr. Speldewinde has not personally reviewed the patient, it is recommended that he be informed one month after the procedure as to the patient’s progress or sooner if there are any questions. Before and during it showing its benefits the patient is strongly advised to increase activity levels as this is a strong reason to have the procedure.