What Is Radiofrequency Ablation?
Radiofrequency ablation (RFA), also called radiofrequency neurotomy, is an advanced interventional procedure that uses precisely controlled heat energy to disrupt the function of the medial branch nerves — the small nerves that carry pain signals from the facet joints of the spine to the brain. By interrupting this pain pathway at the source, RFA can provide relief lasting 9–18 months or longer, significantly outperforming most other non-surgical treatments for chronic axial neck and back pain.
Unlike injections that reduce inflammation temporarily, RFA addresses the structural source of pain transmission. When the nerves regenerate — as they eventually do — the procedure can be safely repeated. Dr. Qureshi performs RFA using fluoroscopic guidance and confirms optimal electrode placement before applying energy, ensuring the highest standard of precision.
Conditions Treated with Radiofrequency Ablation
- Facet joint arthritis (spondylosis) — the most common indication; degenerative changes in the small joints of the spine that cause chronic axial neck or back pain
- Sacroiliac (SI) joint pain — pain originating from the joint connecting the sacrum to the pelvis, common after pregnancy, trauma, or with inflammatory arthritis
- Chronic cervical pain — persistent neck pain with associated headaches, often from whiplash or degenerative joint disease
- Failed back surgery syndrome — ongoing back pain after spinal surgery attributable to facet joint sources
- Zygapophyseal joint syndrome — medically confirmed facet-mediated pain unresponsive to conservative care
How Radiofrequency Ablation Works
RFA works by delivering radiofrequency energy through a specialized needle placed precisely next to the target nerve. The energy generates focused heat (approximately 80°C / 176°F) that disrupts the nerve's ability to transmit pain signals without damaging surrounding structures. The procedure creates a small controlled lesion that effectively "turns off" the pain pathway for months to years.
The key to success is patient selection: Dr. Qureshi requires confirmation of facet-mediated pain with two separate diagnostic medial branch blocks before proceeding with RFA. Patients who achieve 50% or greater relief from both diagnostic blocks are the best candidates and have the highest likelihood of significant, lasting benefit from the ablation.
The Procedure: Step by Step
- Positioning and preparation: You lie face-down on the fluoroscopy table. The skin over the target area is sterilized and numbed with local anesthetic.
- Fluoroscopic guidance: Using real-time X-ray, Dr. Qureshi precisely positions the RFA electrode needle alongside the target medial branch nerve at each level being treated.
- Sensory and motor testing: Low-level electrical stimulation confirms correct nerve localization before heat is applied — this is a critical safety and accuracy step unique to RFA.
- Ablation: Once position is confirmed, the electrode tip is heated for 60–90 seconds per nerve. Multiple nerves are typically treated in the same session (a lumbar RFA typically treats 3–6 nerve sites).
- Recovery: The procedure takes 30–45 minutes. You rest in recovery for 20–30 minutes before going home. A driver is required.
Timeline for relief: Unlike injections, the full benefit of RFA develops gradually. Most patients notice improvement beginning 2–3 weeks after the procedure, with maximum effect at 4–6 weeks. This delay is normal and expected as the treated nerves fully degenerate.
Benefits of Radiofrequency Ablation
- Long-lasting relief — typically 9–18 months, sometimes 2+ years
- Repeatable when nerves regenerate and pain returns
- Significant reduction in oral pain medication use
- Outpatient procedure with rapid return to normal activities (1–3 days)
- Backed by decades of clinical research and high-quality evidence
- Minimally invasive — no incisions, no general anesthesia required
Risks and Side Effects
RFA is a very safe procedure when performed by a trained interventional specialist. The most common experience is post-procedural soreness lasting 1–2 weeks — often described as feeling like a "muscle bruise." Less common effects include:
- Temporary numbness or skin sensitivity in the area served by the treated nerve (usually resolves in weeks)
- Pain flare before improvement begins (normal and expected in the first 2 weeks)
- Neuritis: Rare nerve inflammation causing a temporary burning sensation
- Infection or bleeding: Very rare with proper technique