Understanding Radiofrequency Ablation of Medial Branch Nerves
Radiofrequency ablation (RFA) of the medial branch nerves is a minimally invasive treatment used for persistent back pain that has not improved with conservative care. By applying targeted heat to the small nerves that transmit pain from the facet joints, this procedure can reduce pain signals and help patients move more comfortably. While it is not appropriate for everyone, many people experience meaningful, longer-term relief when other treatments have not been effective.
How the Procedure Works
The medial branch nerves carry pain signals from the facet joints in the spine. When these nerves become irritated, they can contribute to chronic back pain. Radiofrequency ablation uses controlled heat delivered through a specialized needle to create a small, precise lesion on the nerve. This disrupts pain transmission while preserving nearby structures.
The procedure is typically recommended only after confirming the pain source through prior diagnostic injections. Individuals who are pregnant, have certain medical conditions, or cannot safely pause specific medications may not be candidates.
Preparing for and Undergoing Treatment
Before the procedure, patients may be asked to stop medications such as aspirin and blood thinners. They should inform their physician of any allergies to contrast dye, iodine, or latex. Eating and drinking should be avoided for two hours prior. On the day of treatment, patients should shower, avoid lotions, bring recent imaging studies, and arrive early for check-in.
During the procedure, patients lie on their stomach and receive mild sedation while remaining awake. An IV line is placed, the skin is cleaned, and local anesthetic is applied. Using X-ray guidance, the surgeon positions the RFA needle near the medial branch nerves. After confirming placement, an electrode delivers a brief electrical current followed by controlled heat to create the lesion. The procedure generally lasts 30–90 minutes. Patients are monitored afterward and discharged once stable.
Benefits and Conditions Treated
RFA is designed to reduce pain that originates from irritated medial branch nerves connected to the facet joints. Many patients experience improvement in mobility and a decrease in chronic discomfort after treatment. Because the procedure addresses the nerves responsible for transmitting pain, relief may last longer compared to injections or medications alone. For individuals whose pain has persisted despite physical therapy, injections, or medication management, RFA may offer another pathway to more consistent relief.
Aftercare, Risks, and When to Seek Attention
Patients should avoid driving, strenuous activity, and submerging the injection site in water for 24 hours. Bandages can be removed the next day. Mild soreness is common, but symptoms such as spreading redness, warmth, or drainage should be reported.
Although complications are rare, risks include infection, bleeding, temporary pain increase, allergic reactions, nerve irritation, or muscle spasms. Patients should seek immediate medical care if they develop sudden weakness, fever, difficulty breathing, severe headaches, allergic reactions, or changes in bladder or bowel control.