Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Lumbar radiofrequency ablation is a procedure used to treat pain coming from the facet joints in the lower back.
Facet joints are small joints in the back of the spine that help guide movement. Small nerves called medial branch nerves carry pain signals from these joints. Radiofrequency ablation uses heat generated by specialized needles to reduce pain signals from these nerves.
This procedure is usually considered after medial branch blocks have shown that the medial branch nerves are likely carrying a significant part of your pain.
This procedure is done to provide longer-lasting pain relief when the lumbar facet joints have been identified as a likely pain source.
Unlike medial branch blocks, which are short-acting tests, lumbar radiofrequency ablation is intended to provide relief that lasts longer. Relief can last up to 6 months, although the amount and duration of relief varies from person to person.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The procedure is quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day.
The procedure itself usually takes approximately 20 to 30 minutes.
The number of needles depends on which facet joints are being treated. Each facet joint is usually supplied by more than one medial branch nerve, so more than one treatment point is commonly needed.
Most patients describe:
Local anesthetic is used to reduce discomfort. Some soreness after the procedure is common and usually settles with time.
You may walk and do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Do not drive until any numbness, heaviness, or altered sensation has fully resolved. If you feel lightheaded or weak after the procedure, do not drive.
Unlike medial branch blocks, this procedure is not judged by the first few hours afterward. Relief from radiofrequency ablation can take time to develop.
Some patients notice improvement within days. For others, improvement may take several weeks.
It is common to have temporary soreness or a pain flare before the longer-term benefit becomes clear.
Relief can last up to 6 months, although the amount and duration of relief varies from person to person.
Lumbar radiofrequency ablation is a palliative procedure. This means it is designed to reduce pain signals, but it does not cure the underlying condition causing the pain.
For example, if arthritis or degeneration is contributing to the pain, the procedure does not remove the arthritis or reverse the degeneration. Instead, it reduces the ability of the treated nerves to carry pain signals from the lumbar facet joints toward the brain.
Over time, the treated nerves can regrow, and the pain may return. For many patients, this happens on the order of months.
Less pain can sometimes make it easier to participate in physiotherapy, exercise, weight loss, strengthening, or other rehabilitation strategies. In some cases, those changes may reduce the overall pain burden enough that repeat procedures are not needed as often, or are not needed at all.
The next step depends on how much relief you have after the procedure.
If your pain resolves completely, this suggests that the treated lumbar facet joints were the main source of your pain. In that situation, you may not need another clinic visit until the pain returns. When pain returns, it is commonly on the order of 6 months, although this varies from person to person.
If your pain does not improve, or only partially improves, we would usually see you again in clinic to reassess. This may mean considering another diagnostic procedure, another therapeutic procedure, reviewing imaging, ordering updated imaging, or discussing a different treatment plan.
Some patients have more than one source of pain. Lumbar radiofrequency ablation may help treat lumbar facet joint pain, but it may not explain or treat all of your symptoms.
Keep the procedure sites dry for 24 hours. Remove bandages after 24 hours.
If you develop a pain flare or sunburn-like nerve irritation, this usually improves with time. Ice packs and over-the-counter pain relievers may help if you are allowed to use them. Avoid unusually strenuous activity for the rest of the day.
Lumbar radiofrequency ablation is a low-risk procedure when performed with X-ray guidance and sterile technique. Serious complications are very rare.
The most common issues are temporary soreness, bruising, lightheadedness, or a short-term increase in pain. These usually settle on their own.
A temporary irritated-nerve pain can occur after lumbar radiofrequency ablation. This may feel like burning, tingling, sensitivity, aching, or a deep sunburn-like pain over the treated area. This is usually temporary, but it can be uncomfortable while it is settling.
Uncommon risks include bleeding under the skin, temporary numbness from local anesthetic spreading to nearby nerves, or an allergic reaction to a medication used during the procedure.
Serious complications such as infection, significant bleeding, skin burn, or nerve injury are extremely uncommon.
Seek medical attention if you develop fever greater than 38.5°C, worsening redness or swelling at the procedure site, drainage from the procedure site, new leg weakness, or severe worsening pain that does not settle.
The procedure itself, including the clinic visit and use of X-ray guidance, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, steroid medication, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
Tell us before the procedure if you take blood thinners. We may need to adjust them before the procedure to reduce bleeding risk. This will be reviewed with you in advance.
Tell us before the procedure if you have ever had an allergy or serious reaction to local anesthetic, steroid medication, or antiseptic skin-cleaning solution.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.