Radiofrequency Ablation
A minimally invasive procedure that uses heat to interrupt the nerves transmitting facet joint pain
Radiofrequency ablation (RFA), also called radiofrequency neurotomy, uses a heat probe to disrupt the medial branch nerves that carry pain signals from the facet joints of the spine. When facet joint arthritis or injury causes chronic axial back pain, and diagnostic medial branch blocks have confirmed the facet joints as the pain source, RFA can provide durable relief lasting 6–18 months. Unlike injections, which reduce inflammation temporarily, RFA physically interrupts the pain signal pathway — the nerve eventually regenerates, but relief is significantly longer-lasting.
Who Is a Candidate?
- Chronic axial back or neck pain confirmed to be facet joint in origin
- Positive response (≥50% pain relief) to two diagnostic medial branch block injections
- Failed conservative care including physical therapy and anti-inflammatory medications
- Pain primarily in the spine itself (not radiating down the arm or leg)
- Lumbar facet syndrome, cervical facet arthritis, or post-surgical axial pain
What to Expect
1Before Surgery
Two diagnostic medial branch block injections must be performed before RFA to confirm that the facet joints are the source of pain. If both blocks provide ≥50% temporary relief, you are a candidate for RFA. Inform your doctor about blood thinners. The procedure is performed outpatient; arrange a driver.
2The Procedure
You lie face-down on a fluoroscopy table. After skin numbing and sedation if desired, the physician uses X-ray guidance to place a radiofrequency needle adjacent to the medial branch nerve at each target level. Electrical stimulation confirms correct placement (you may feel tingling or muscle twitching). The nerve is then heated to 80–90°C for approximately 90 seconds per level, creating a controlled lesion. Treating both sides of two to three spinal levels takes 45–60 minutes total.
3Recovery
Soreness at the needle insertion sites is common for 2–3 days and can be managed with ice and over-the-counter analgesics. Some patients experience a temporary pain flare in the first 1–2 weeks as the nerve responds to treatment — this resolves. Full activity typically resumes within 1 week. Meaningful pain relief usually begins 2–4 weeks after the procedure.
Typical Outcomes
70–80% of appropriately selected patients report significant pain relief after radiofrequency ablation. The effect typically lasts 6–18 months. Because the medial branch nerve regenerates over time, the procedure can be repeated when pain returns — with comparable results on subsequent treatments. RFA is most effective when the diagnosis has been confirmed with two positive diagnostic blocks.
Risks & Considerations
- Temporary soreness or bruising at needle insertion sites (common)
- Temporary numbness or tingling in the skin near the treatment site
- Temporary pain flare in the first 1–2 weeks post-procedure
- Infection (rare, <1%)
- Incomplete relief if facet joints are not the sole pain generator
- Nerve regeneration within 6–18 months (relief is not permanent)
Frequently Asked Questions
How long does radiofrequency ablation last?
Most patients experience relief for 6–18 months. The medial branch nerve slowly regenerates after RFA, and pain may gradually return as the nerve regrows. The procedure can be repeated when this occurs, typically with similar results. Some patients report longer-lasting relief after a second treatment.
Do I need to have diagnostic blocks before radiofrequency ablation?
Yes. Most insurance carriers and evidence-based guidelines require two positive medial branch block injections (each providing ≥50% pain relief) before approving RFA. The diagnostic blocks confirm that the facet joints are the source of your pain — without this confirmation, RFA may not provide meaningful relief.
Is radiofrequency ablation the same as a nerve block?
No. A nerve block (medial branch block) is a diagnostic injection that temporarily numbs the nerve to confirm it is the pain source — it lasts only hours to days. Radiofrequency ablation physically disrupts the nerve with heat, providing lasting relief for 6–18 months. They are used in sequence: blocks first to diagnose, RFA to treat.
Can I have radiofrequency ablation in my neck?
Yes. Cervical RFA targets the medial branch nerves of the cervical facet joints and is performed for chronic neck and upper back pain confirmed to be facet in origin. The technique and eligibility criteria are the same as for lumbar RFA. Cervical RFA carries a slightly higher technical complexity due to proximity to vascular structures.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed April 2026. CPT: 64635.