Facet Ablation (Rhizotomy) Treatment

Targeted Nerve Ablation for Facet Pain

Who Benefits from Radiofrequency Ablation?

• Patients with chronic Facet Joint Disease (spondylosis) in cervical, thoracic, or lumbar spine
• Individuals with chronic mechanical back pain or neck pain confirmed by positive diagnostic medial branch blocks (50-75%+ pain relief)
• Those with pain from degenerative facet joints without significant spinal instability or nerve compression
• Patients with Osteoarthritis of the spine causing localized pain that worsens with extension or twisting
• Individuals seeking long-lasting relief (6-12+ months) from facet-mediated pain
• Those unresponsive to conservative treatments including Physical Therapy, medications, and corticosteroid injections
• Patients looking to avoid or delay spinal fusion surgery

What Conditions does Facet Ablation (Rhizotomy) Treatment Help Ease?

This procedure may help with:

The Radiofrequency Ablation Procedure

1. Pre-Procedure: Diagnostic Medial Branch Blocks

   Before RFA, patients must undergo one or two diagnostic medial branch blocks to confirm the facet joints as the pain source. These blocks temporarily numb the medial branch nerves with local anesthetic. If you experience at least 50-75% pain relief for several hours, you're a candidate for RFA.

2. Procedure Day Preparation

   Following consultation and successful diagnostic blocks, RFA is performed as an outpatient procedure. The procedure site is thoroughly cleaned and draped in a sterile manner. Local anesthetic is used to numb the skin and deeper tissues.

3. Fluoroscopic Needle Placement

   Under continuous fluoroscopic (X-ray) guidance, specialized RFA cannulas (hollow needles with electrodes) are placed near the medial branch nerves at multiple levels, typically targeting 3-4 nerve branches per side to cover the affected facet joints.

4. Nerve Localization and Testing

   Before ablation, sensory and motor nerve testing is performed to ensure the electrode is positioned correctly near the target sensory nerve and away from motor nerves that control muscles. This safety step prevents unintended nerve injury.

5. Radiofrequency Lesioning

   Once proper positioning is confirmed, radiofrequency energy is delivered through the electrode, creating a controlled heat lesion (80-90°C) that deactivates the pain-transmitting medial branch nerves. The heat disrupts the nerve's ability to send pain signals from the facet joint to your brain.

6. Multiple Levels Treatment

   The process is repeated for each target nerve. The entire procedure typically takes 30-60 minutes depending on how many levels are treated. Mild discomfort or pressure may be felt during the lesioning, but the area is numbed to minimize pain.

Benefits of Facet Ablation (Rhizotomy) Treatment

• Offers significant and often long-lasting relief (6-12+ months) from chronic facet joint pain
• Is a minimally invasive outpatient procedure with low risk and minimal downtime
• Provides targeted pain relief by deactivating specific pain-transmitting medial branch nerves
• Can lead to a substantial reduction in the need for oral pain medications, including opioids
• Improves spinal mobility and function by alleviating restrictive pain
• Can be safely repeated when pain returns as nerves regenerate
• May help patients avoid or delay the need for spinal fusion surgery

Recovery from Radiofrequency Ablation

Same-Day and Days 1-3: Recovery from Radiofrequency Ablation (Rhizotomy) is generally quick. Resume light activities within 24-48 hours. Temporary soreness, muscle spasm, or slight increase in pain at the treatment site is common but typically resolves within 3-7 days. Ice and over-the-counter pain relievers help manage post-procedure discomfort.

Days 3-14: As the ablated nerves degenerate, pain relief gradually develops. Some patients experience immediate improvement, while others take 2-4 weeks to notice maximum benefit. This variability is normal and depends on individual healing responses.

Weeks 2-8: Most patients reach maximum pain relief during this window, with significant reduction in facet-mediated pain. Improved mobility and function become apparent, allowing return to normal daily activities and exercise.

Months 2-12+: Pain relief typically lasts 6-12+ months, with many patients experiencing relief for 12-24 months or longer. The duration depends on how quickly the nerves regenerate. Physical Therapy is often recommended after this minimally invasive pain procedure to improve core strength, posture, and maintain spinal mobility, aiding in long-term pain control and functional restoration.

If RFA Doesn't Work: If pain relief is minimal after 6-8 weeks, the facet joints may not be the primary pain source. Alternative diagnoses should be explored, including discogenic pain, SI joint dysfunction, or muscular causes. Second opinions and complimentary MRI reviews are available.

When Pain Returns: If facet pain recurs after successful RFA (typically 6-18 months later as nerves regenerate), the procedure can be safely repeated with similarly high success rates. Many patients undergo RFA every 12-18 months as needed.

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Locations Offering Evaluation

Our board-certified specialists offer facet ablation (rhizotomy) treatment evaluation and treatment at locations across Florida, New Jersey, New York, and Pennsylvania. Schedule a consultation at a clinic near you.