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Rhizotomy and radiofrequency ablation in Perth

Radiofrequency neurotomy, often called rhizotomy or radiofrequency ablation, uses heat to interrupt selected nerves carrying pain signals. Dr Chris Martin assesses suitability for image-guided spinal and joint procedures in Perth. The expected benefit depends on the diagnosis, target nerve and response to previous care.

Where a facet joint or other structure has been identified as generating pain — often with the help of diagnostic nerve blocks — radiofrequency neurotomy offers longer-lasting relief. A fine insulated probe is placed alongside the target nerve and used to interrupt pain transmission from the painful structure.

Types of treatment

Rhizotomy — interrupting the nerve supply to a painful structure — is performed here with three techniques, each with its own place. Thermal (conventional) radiofrequency uses heat to create a small, controlled lesion in the target nerve and is the standard technique for spinal facet and sacroiliac denervation. Pulsed radiofrequency delivers short, low-temperature electrical impulses that settle a nerve's pain signalling without a heat lesion; it is not equivalent to thermal ablation and is chosen for different targets. Cryoablation interrupts the nerve with extreme cold rather than radiofrequency energy. Their indications, durability and evidence differ, and the consultation establishes which, if any, suits your situation.

How long it lasts

The treated nerves regenerate over time, and pain commonly returns as they do. With careful selection, relief usually lasts somewhere between six and twelve months, though there is wide individual variation — some people get considerably longer, some considerably less. The procedure can generally be repeated when the effect wears off.

How well it works

Response varies with the condition, nerve target, technique and selection process. A useful response to diagnostic blocks may support proceeding in some clinical pathways, but does not ensure a successful outcome. Some people do not obtain meaningful benefit. The consultation should cover the evidence relevant to your diagnosis, reasonable alternatives and the goals against which treatment will be assessed.

What it does not treat

Facet medial branch radiofrequency targets pain arising from the facet joints. It does not decompress a nerve root, remove a disc protrusion or widen the spinal canal. Other nerve targets and pulsed radiofrequency procedures have different indications and should be discussed separately.

On the day

The procedure is done under X-ray guidance, usually with light sedation. Needle placement is precise and image-guided. Before treatment is delivered, electrical stimulation is used to confirm the probe is beside the intended nerve and away from nerves supplying the limbs. Each lesion takes a couple of minutes; several are usually made. Expect to be in the procedure room 30–60 minutes.

Afterwards

Soreness in the treated area for one to two weeks is normal and sometimes exceeds your usual pain in the first few days. A patch of numbness over the skin is common. Benefit is often not apparent for two to three weeks, and the full effect may take four to six weeks — so early judgement is unreliable. You will need someone to drive you home.

Where it is used

Radiofrequency neurotomy (rhizotomy) is performed at every level of the spine — cervical (neck), thoracic (mid-back) and lumbar (low back) facet joints, and the sacroiliac joint — and for the nerves supplying painful joints: the genicular nerves of the knee, the suprascapular and axillary nerves of the shoulder, and the articular branches of the hip. Spinal rhizotomy and joint denervation are the largest part of Dr Martin's procedural practice.

Risks

Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

What should happen next

Relief is a window, not an endpoint. A rehabilitation plan during that window is what determines whether the improvement translates into lasting function.