Lumbar Radiofrequency Denervation

Lumbar: Low back
Radiofrequency: Electrical heat production
Denervation: Interruption of nerve conduction
Frequency: Usually performed after a patient has successfully completed lumbar medial branch blocks with at least 50% pain relief for the duration of the local anesthetic.
Anesthetic:  Local +/- IV sedation

Indications:  The second leading cause of mechanical low back pain is arthritis in your joints of your lower back.  This condition is typically not fixed by surgery. This procedure is used to treat your pain coming from the arthritic joints in your low back.  Usually for low back pain that can radiate to buttocks/hips and sometimes to knees but usually not helpful for pain below the knees.

Contraindications/Reasons why you may not have your injection today:

• Bleeding disorders/low platelet counts
• Medications that thin your blood (please review this section)
• Current infection
• No driver
• Your symptoms have changed and/or improved
• Patient refusal
• Procedure not approved by your insurance
• Poorly controlled high blood pressure that may be giving you symptoms
• Allergies to the any of the medications that is being used

 
Potential side effects/risks of the procedure:

• Increased pain
• Numbness in lower extremities that is short lived
• Infection
• Bleeding
• Allergic reaction to medications used to clean your skin and/or medications injected
• Seizures
• Stroke
• Nerve and/or spinal cord injury

 
Procedure: 
During the procedure, you will be lying on your stomach.  An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain based upon where you hurt in your low back.  After your skin is cleaned with an antiseptic solution, normally betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement.  The skin is localized with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected.  Another needle is then placed through the numb area of your skin and guided by the x-ray machine to the location of where the nerve sits.  This is done several more times in your low back until all needles are in place.  The needles will then be connected to a radiofrequency generator and the nerves that are to be disrupted are stimulated.  This will likely produce an unpleasant twitching in your low back/buttock/hip region.  If any pain/twitching travels past the knee at any time during the procedure, please notify your physician.  When satisfactory stimulation is achieved, additional local anesthestic is placed on the nerves.  Finally, lesioning of these nerves begins.  You may experience increased pressure/pain in your low back/buttocks region which is normal.  However, if at any time the pain is too intense, please tell your physician who can provide more local anesthetic.  After the lesioning is complete, the needles are removed and the procedure is completed.

Typical length of the procedure: 
15 minutes.  Expect to be at the clinic no more than 20 minutes after you have been checked in by the medical assistant into the preoperative area.  If this is your first injection and/or you have had sedation, you will likely be at the clinic for at least one hour.  Please plan accordingly.

How long do you expect pain relief: 
On average, patients will gain at least 50% pain relief for 6 months.  This relief may not be immediate and can take several weeks before adequate pain relief is achieved.  If the pain returns after this time frame, the procedure can be repeated.