There are numerous structures in your spine that can cause lower back and/or leg pain. The facet joints are a frequent cause of lower back pain. They are highly innervated with little nerves whose sole job is to provide sensation from them. These are the joints in your spine that allow you to twist and bend forward, backward and sideways. They take a lot of stress and loading over the course of our lives. They may become arthritic enough so that we can even see the degeneration on X-rays or MRI. However, many times we cannot see an abnormality on radiographic studies, although we still believe that these joints are generating all or some of your lower back and/or leg pain. Chronic pain from the facet joints really serves no purpose except to detract from your quality of life. If you obtained relief from the diagnostic "test" blocks of these joints, RF denervation is performed almost exactly the same way, except that we use special needles to destroy the facet nerves with heat. Remember, they are there only to send pain signals, and without them, you will not feel any numbness or weakness in any muscles. The goal of RF facet denervation is to provide long-term pain relief. Studies have shown 50 percent of patients experience relief lasting up to two years. Eventually, the nerves regenerate and your pain may return, at which point the RF denervation procedure can be repeated. Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.
As with most procedures, there is a remote risk of bleeding, infection, nerve injury or allergic reaction to the medications used. In addition, the injections may cause some temporary soreness in your back. Using an ice pack should help. Last, there is also a chance that the procedure will not work to relieve your pain.
After you check in and sign a consent form, you will have an IV placed. In the procedure room, you will be positioned on your stomach on a narrow table. We will sedate you with medication in your IV to make you comfortable. Your back will be cleaned with a special solution. We will then use an x-ray machine (fluoroscope) to locate the exact spots for denervation. The doctor will numb your skin, which may pinch a little. Once the needles are inserted, we will test to make sure they are in the appropriate locations. Each nerve will then be "heated" and destroyed, but you should not feel this, as we will numb each nerve first. The procedure will take 25 to 35 minutes, after which you will be taken to the recovery room and discharged shortly thereafter, once your sedation wears off.
Following your procedure, you may not drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing. You may resume taking your normal pain medications, and the doctor will give you a prescription for a short course of additional pain medicines following the procedure, if needed. Remember that you will most likely be sorer after this procedure than you were following the diagnostic facet blocks you had earlier.
You should call us immediately at 781-744-5090 if you experience any of the following:
Remember that it may take upwards of a week to know how much relief you will experience from this procedure. Optimal relief may take four to six weeks.