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Cervical Radiofrequency Ablation

What it Treats, Side Effects, And Why It Should be Avoided

Cervical radiofrequency ablation is used to treat cervical facet mediated pain.  Cervical facet pain can come in many types of pain from muscle spasms, neck pain, shoulder pain, sharp, stabbing, throbbing, deep ache, upper back pain, mid back pain, headaches, and much more.  Pain is generated by several small nerves that innervate the facet joint (medial branch nerves).  Radiofrequency ablation is a technique used by traditional interventional pain management physicians.  Cervical Radiofrequency ablation burns the nerves (medial branches) that innervates the facet joints to cut off the pain signal.

BUT if you are asking yourself, “is burning a nerve to help pain the best thing for my neck?”, then you are not alone!  Let’s take a deeper look into radiofrequency ablation and also discuss healthier alternatives that can help!

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 has 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.

Variations of Cervical Radiofrequency Ablation

Over the years there have been several different variations of ablations. 

Thermal or Conventional RFA

A radiofrequency current is created which causes energy to pool in the tissue. This energy converts into heat which creates a small lesion on the nerve rendering it unable to transmit pain signals.

Pulsed RFA

Like thermal, however, a higher voltage is used in a pulsing/alternating fashion, allowing the energy to dissipate more easily and less heat to generate. This particular type of RFA leaves the nerve intact, while selectively “shocking” the A-delta and C fiber (pain conductors) which are responsible for generating pain signals.

Water-Cooled or Cooled RFA

Using a multi-channel electrode that is actively cooled by a continuous flow of water, the radiofrequency current is prevented from reaching temperatures as high as thermal/conventional. This effectively creates a larger and more complete lesion to ensure nerve burn is as complete as possible.

What Happens During The Procedure? 

What does cervical radiofrequency ablation look like from the patient’s perspective?

The patient must undergo diagnostic blocks (1 to 2 blocks) prior to being approved for the eventual burning. 

These are where the physician places anesthetic around the nerves that they would plan to burn and test to see if numbing the nerve takes the pain way

You record your pain on chart and review with a physician after procedure to decide if the test blocks were successful and if so then move on with burning of the nerves.

Procedures (even diagnostic blocks) are typically completed at an outpatient ambulatory surgical center (ASC)

Being done an ASC does significantly increase the cost of each procedure.

radiofrequency ablation step 1 - inject facet joints with numbing injections

The patient goes under conscious sedation for the procedure. Needles are then guided to the location under X-ray guidance. Please see the photo to the left. When the needle tip is in the proper location, electrodes are placed through the needle, and then electric charges are passed into tissue creating a cautery effect to the nerve and surrounding tissue.

Is Radiofrequency Ablation Painful? raadiofrequency ablation for neck pain

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 can be treated with Radiofrequency Ablation

RFA has been used since the late 1970s. Traditionally FRA has been used for spinal pain from arthritis facet joints but over the years has been expanded to treat other conditions as well:

  • Spinal Arthritis
  • Sacroiliitis / Sacroiliac joint arthritis
  • Neck Pain from facet arthritis
  • Shoulder Pain such as post stroke shoulder apin
  • Chronic Low Back Pain from facet arthritis
  • Chronic knee pain (even after a knee replacement)

What are the Side Effects of Radiofrequency Ablation?

Radiofrequency ablation for neck pain is associated with a number of side effects which include:

Infection

Infection may involve the skin or deeper structures such as muscle and bone.  Antibiotics are often required.

Nerve Damage

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).

Skin Numbness

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.

Dizziness

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).

Hyperesthesia

An excessive, abnormal sensitivity over the skin of the injection site.  Many patients relate this sensation to a really bad sunburn.  Where the skin overlying the area is abnormally hypersensitive to even light touch. This can last several days to weeks.

Allergic Reaction

In the procedure, to ensure proper placement of need, contrast is used to confirm.  Some patients are allergic to the contrast and an allergic reaction is possible.

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 reduce 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 the tendon, ligament, and facet injuries.

Make Your Treatment Less Painful But More Effective

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 needs to repeat almost annually.   PRP and bone marrow concentrate are effective, natural options for radiofrequency ablation and the management of cervical facet pain.

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Doctors Who Provide an Alternative to RFA at Centeno-Schultz Clinic (Regenexx Colorado)

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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References

1.Yahia LH, Garzon S. Structure on the capsular ligaments of the facet joints. Ann Anat. 1993;175(2):185–188.DOI: 10.1016/s0940-9602(11)80179-2.

2.Jaumard NV, Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng. 2011;133(7):071010.doi: 10.1115/1.4004493.

3.Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. 1990;15(6):453-7..DOI: 10.1097/00007632-199006000-00004

4.Prushansky T, Pevzner E, Gordon C, Dvir Z. Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures. J Neurosurg Spine. 2006;4(5):365-73.DOI: 10.3171.

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
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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.