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Doctors often recommend radiofrequency denervation for patients with good results from a diagnostic or (medical branch) injection. If the pain is somewhat numbed with this injection, the pain source is likely to be from the facet joints. Radiofrequency denervation is often used for more long-lasting results.
What to Expect:
There are 2 types of radiofrequency denervation: heat lesions and pulsed lesions. The lesions are performed using an insulated needle through which an inner cannula (or catheter-like device) is placed. Using x-ray (fluoroscopy) as guidance, the needle is placed at the site of the nerves to the facet joints and then advanced until it hits the bone. To ensure the needle is in the correct position, the nerve is then stimulated. Sensory and local stimulation are performed. Sensory stimulation detects the lowest threshold the patient feels and if positive, may recreate the patient's pain. Motor testing involves placing the needle near a nerve root while the patient notifies the doctor of any involuntary movement of the associated extremity. If this is negative and the sensory stimulation is positive then a lesion may be performed.
A heat lesion, which is used to destroy the nerve, is usually performed at 80 degrees for 90 seconds, often with a prior injection of numbing medication. The physician should be notified of any pain to the affected extremity during the lesion. If the lesion is conducted in the pulsed mode, it is performed under low heat of 42 degrees for 120 seconds. The pulsed lesion does not destroy but disables the nerve. There have been no reports of joint degeneration following these lesions.
Lumbar Facet Denervation
Side Effects:
The most common side effect following radiofrequency denervation is soreness in the area where the needles were placed. Local application of cold compresses immediately following the procedure will relieve some of the discomfort. The pain relief from the procedure may be immediate or may be delayed by up to 10 days.
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