Neck pain can rob you of your quality of life. What is a cervical facet? What is a Radiofrequency Ablation? Is radiofrequency ablation for neck pain painful? What are the side effects of radiofrequency ablation for neck pain? What are the regenerative medicine treatment options? Let’s dig in.
What is a Cervical Facet?
Neck pain can arise from different structures in the spine that include the muscles, tendons, ligaments, discs and facet joints. Facet joints also referred to as zygapophysial joints or Z joints are located in the back portion of the spine. Each of us have two facet joints per cervical level, one on the right and one of the left. They provide support, stability and facilitate motion in the neck. Like other joints in the body such as the knee or ankle joint, the cervical facets are lined with cartilage (1). Cervical is the medical term for the neck. The cervical facets are susceptible to injury due to trauma such a rear-end motor vehicle accident, martial arts which can cause significant pain and restriction in neck movement (2). Pain from the injured cervical facet can be localized at the level of the injury or can be referred to the shoulders or scapula (3) as illustrated to the right.
What is a Radiofrequency Ablation?
Radiofrequency Ablation also referred to as RFA or Radiofrequency neurotomy (RFN) is a medical procedure utilized to treat facet related pain (4). Ablation means to remove or to destroy. Radiofrequency ablation uses heat energy to destroy the nerve or nerves that transmit the pain signals. The procedure involves placing needles near the nerve that transmits pain signals from the damaged cervical facet joint.in the neck to the brain. This needle is then heated thereby barbecuing the nerve and adjacent tissue which kills the nerve and stops the transmission of pain. Radiofrequency ablation for neck pain does not treat the underlying issue as the cervical facet remains injured. It simply turns off the pain signal by burning the nerve. Pain relief is temporary as the nerve grows back. Pain relief on average is about 6-12 months.
Is Radiofrequency Ablation Painful?
Radiofrequency ablation for neck pain is painful. A needle is placed in your neck and then heated to destroy the nerve and adjacent tissue. Ouch. The needle is heated up to 194 degrees Fahrenheit (5). For comparison, 165 degrees Fahrenheit is the recommended temperature to cook your burgers on the grill.
What are the Side Effects of Radiofrequency Ablation?
Radiofrequency ablation for neck pain is associated with a number of side effects which include:
Infection may involve the skin or deeper structures such a muscle and bone. Antibiotics are often required.
Radiofrequency ablation targets the nerves that transmit the pain signal from the cervical facet to the brain. Unfortunately, the nerves that control strength and feeling in the arm and hand are nearby and can be temporarily or permanently damaged.
Heavy or Weak Head
Radiofrequency ablation for neck pain can also result in neck muscle weakness. Some of our patients have described their head as feeling like a bowling ball on a golf tee after the procedure due to the muscle weakness (6).
Most patients after radiofrequency ablation for neck pain will complain about severe skin pain like a sunburn for 10-14 days followed by months of skin numbness in the neck. This is the result of the nerve being burned.
The muscles in the upper cervical spine are critical to our sense of position and balance. Radiofrequency ablation for neck pain destroys important nerves which can compromise muscle function and balance (7).
Phrenic Nerve Injury
The phrenic nerve is an important nerve as it controls your ability to breathe. Radiofrequency ablation for neck pain has been reported to injure the phrenic nerve (7). Feeling short of breath with ongoing neck pain is not a good combination.
Atrophy of Supporting Muscles
Atrophy refers to a decrease in size or wasting away of a specific tissue Muscle atrophy means a decrease in the size of muscles. A case in point is Christopher Reeves who traumatically sustained a spinal cord injury. Prior to the injury, he had very strong, well-defined muscles. After the injury, his muscles atrophied and became small. Radiofrequency ablation has been associated with atrophy of the key supporting muscles in the spine (8).
Regenerative Medicine Options
At the Centeno-Schultz Clinic we focus on regenerative medicine. We seek to support nerve health using the body’s healing agents, not destroy them. An injured facet joint that is causing neck pain, muscle spasm and restriction in range of motion is best treated by addressing the underlying joint as opposed to disrupting the pain signal to the brain through the burning of a nerve. At the Centeno-Schultz Clinic we have extensive experience in the treatment of neck pain. Treatment options include PRP and bone marrow concentrate. Both are precisely injected via ultrasound or x-ray guidance by a board-certified, fellowship-trained physician. PRP is rich in growth factors that can increase the blood flow to a given area as well as reducing the inflammation and have been effective in the treatment of facet injuries (10). Bone marrow concentrate contains many different types of cells that include repair cells that can accelerate your body’s natural healing process of tendon, ligament, and facet injuries.
Facet joints are important structures located in the back portion of the spine. They provide stability, support, and motion and are susceptible to injury with resultant pain and restriction in range of motion. Radiofrequency ablation (RFA) is a medical procedure utilized to treat facet related pain. RFA for neck pain involves the destruction of the pain transmitting nerves thereby limiting the pain signal to the brain. The underlying joint remains injured and susceptible to additional injury. The procedure involves high temperatures with the destruction of the nerve and adjacent tissue which is painful. Relief is short term as the nerve grows back with the return of the pain. Side effects from radiofrequency ablation for neck pain include infection, escalation in pain, nerve damage, heavy head, dizziness, difficulty breathing, and atrophy of supporting muscles. At the Centeno-Schultz Clinic, we are experts in regenerative medicine. Treatment of the underlying facet injury is best for optimal long term success as opposed to the burning of nerves with its significant side effects and need to repeat almost annually. PRP and bone marrow concentrate are effective, natural options to radiofrequency ablation and the management of cervical facet pain.
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5.Costandi S, Garcia-Jacques M, Dews T, et al. Optimal Temperature for Radiofrequency Ablation of Lumbar Medial Branches for Treatment of Facet-Mediated Back Pain. Pain Pract. 2016;16(8):961-8.DOI: 10.1111/papr.12346.
6. Stoker GE, Buchowski JM, Kelly MP. Dropped head syndrome after multilevel cervical radiofrequency ablation: a case report. J Spinal Disord Tech. 2013;26(8):444-8.DOI: 10.1097/BSD.0b013e31825c36c0.
7.Andrew Engel, MD, George Rappard, MD, Wade King, MMedSc, MMed(Pain), David J. Kennedy, MD, on behalf of the Standards Division of the International Spine Intervention Society, The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data, Pain Medicine, Volume 17, Issue 4, April 2016, Pages 658–669, https://doi.org/10.1111/pme.12928
9.Dreyfuss P, Stout A, Aprill C, Pollei S, Johnson B, Bogduk N. The significance of multifidus atrophy after successful radiofrequency neurotomy for low back pain. PM R. 2009;1(8):719-22. DOI: 10.1016/j.pmrj.2009.05.014
10.Urits I, Viswanath O, Galasso AC, et al. Platelet-Rich Plasma for the Treatment of Low Back Pain: a Comprehensive Review. Curr Pain Headache Rep. 2019;23(7):52.