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Radiofrequency neurotomy

Radiofrequency neurotomy interrupts the small nerves that carry pain signals from a painful joint or structure, providing relief that typically lasts several months to around a year. Techniques include thermal radiofrequency, pulsed radiofrequency and cryoablation, chosen to suit the nerve being treated.

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. These procedures take several forms: thermal (conventional) radiofrequency, which uses heat to create a small controlled lesion; pulsed radiofrequency, which delivers short, low-temperature electrical impulses that settle the nerve's pain signalling without heat destruction; and cryoablation, which interrupts the nerve using extreme cold. Which technique suits you depends on the nerve being treated and your situation, and Dr Martin will explain the choice.

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. Outcomes depend heavily on selection. Studies applying rigorous selection criteria before treatment report substantially better results than those that do not — careful selection matters. Even with good selection, a proportion of people do not get a useful response. Dr Martin will give you a realistic expectation for your situation rather than a headline figure.

What it does not treat. Radiofrequency neurotomy targets facet joint pain. It does not treat pain coming from a disc, from a compressed nerve root, or from the spinal canal. If your pain radiates down a limb in a nerve distribution, this is unlikely to be the right procedure and a different assessment applies.

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.