Breakthrough Treatment and Technology

Radiofrequency Ablation of the Facet and Sacroiliac Joint Nerves

Cynthia T. Chin, MD
Associate Professor of Radiology and Neurosurgery
University of California, San Francisco
San Francisco, California

Radiofrequency Ablation (RFA) of the facet and sacroiliac joints is one of the pain management services offered by neuroradiologists at UCSF Precision Spine and Peripheral Nerve Center. Neuroradiologists use RFA radio waves to produce heat to precisely disable a facet or sacroiliac joint nerve from transmitting pain. Radiofrequency ablation is a routine procedure performed by our physician specialists. The precise placement of these waves is facilitated by CT-guidance using our state of the art 64-slice CT scanner.

Spine Center
Our doctors, nurses, and technicians are with you throughout your procedure. As a team, we work together to maximize your safety and comfort.

How RFA Relieves Pain

Your cervical (neck) facet joints are located near each side of the neck vertebra. The thoracic (mid back) and lumbar (low back) facet joints are located at the back of your spinal column. You have two sacroiliac (SI) joints located in your lower back behind the pelvis on either side of the spine in the sacral region. Nerves transmit pain signals from diseased joints to the spinal cord, which in turn sends the pain message to the brain. Your brain perceives the message as "pain". RFA interrupts pain transmission by disabling pain fibers from the facets.

Patient Selection

Patients with degenerative and/or postoperative disease affecting the upper cervical and lower back may benefit. Of course, accurate diagnosis and patient selection is important to the success of any pain management therapy. Before radiofrequency ablation is considered, the patient's source of pain is determined and confirmed by one of several procedures:

  • Diagnostic facet block
  • Medial branch nerve block
  • Sacroiliac joint block

Each of the above-listed injection procedures is performed using CT-guidance. If the diagnostic injection relieves the patient's pain symptoms, then s/he may be a candidate for RFA.

Advantages and Risks (Indications/Contraindictions)

Advantages

  • RFA is a safe, nonsurgical treatment for spine pain related to degenerative and postoperative disease.
  • Real time CT-guidance is used during the procedure for precise RFA needle placement, medication delivery, and nerve ablation.
  • Nerves naturally re-grow, sometimes in about six months. If pain recurs the procedure can be repeated.

Risks

  • There are small risks associated with radiation procedures. However, our dedicated neuroradiologists use every available technique to minimize your radiation exposure (dose) while striving to achieve the best therapeutic outcome.
  • If you take anticoagulants, we are careful to make sure you have stopped this medication at an appropriate time before radiofrequency ablation to reduce bleeding risk.
  • We use a sterile technique to reduce your risk for infection.
  • Needle placement under CT-guidance and testing the nerve before radiofrequency ablation reduces the potential for inadvertent nerve damage.

About a RFA Procedure

The procedure is performed using CT-guidance, similar to a diagnostic block. You are sedated and monitored at all times by our superb nursing staff and physicians.

A thin needle is precisely inserted at the appropriate spinal level. The needle is advanced near the targeted pain-transmitting nerve. Once the needle is in place, numbing medication is injected. Radiofrequency stimulation (ablation) is delivered through the same needle. It takes about 90 seconds and the procedure is repeated at each needle site.

After the procedure, you may experience some mild transient pain in the treatment area. This procedure pain should subside during the following 10 days to two weeks. Since nerves re-grow, sometimes in about six months, if pain recurs, the procedure can be repeated.

How Long Does a Procedure Take?

We recommend you allow one to two hours for the procedure.

Before Your Procedure through Aftercare

The UCSF Precision Spine Center's wonderful and caring nurses are with you from the time you arrive, throughout your radiofrequency ablation procedure, and during recovery. We are here to answer your questions and follow up with you by phone or email.

Questions

Answers to the many questions patients ask are provided in the UCSF Precision Spine and Peripheral Nerve Center's Pretreatment Patient Guide and Discharge Instructions and Home Care Patient Guide. Of course, we welcome your questions and look forward to providing you with exceptional care before, during and after your procedure.