A longer-lasting follow-up to a positive diagnostic block — using precisely targeted heat energy to quiet the small nerves that carry facet-joint pain.
Radiofrequency ablation — usually shortened to RFA — uses controlled heat energy from the tip of a small probe to interrupt the tiny medial branch nerves that carry pain signals from your facet joints to your brain. The probes are placed under fluoroscopy with great precision. The procedure does not touch the spinal cord, the nerve roots that travel to your arms or legs, or any of the structures that control motor function. It works on the small sensory nerves that primarily transmit pain signals from the facet joints identified as the source.
RFA is performed only after one — and usually two — positive medial branch blocks have confirmed the diagnosis. That sequence is deliberate. RFA is more involved than a single injection, takes longer to deliver its benefit, and we want to be confident that it's targeting the right structures before we proceed. Careful selection with diagnostic blocks improves the likelihood of benefit, but a positive block does not guarantee a successful or durable response.
RFA is for patients whose chronic axial back or neck pain has been confirmed as facet-mediated by diagnostic blocks. It's a step beyond first-line care — physical therapy, activity modification, anti-inflammatory medication, and shorter-acting injections have usually been tried first.
RFA is generally not appropriate if your diagnostic blocks were negative or unconvincing, if your dominant pain is radicular (radiating down an arm or leg from a nerve root) rather than axial, or if there is active infection, uncontrolled bleeding risk, or implanted medical hardware in the treatment area that interferes with safe probe placement. We'll review your imaging and any prior procedures carefully when planning.
We confirm the levels being treated, review the diagnostic block results, and position you face-down on the fluoroscopy table. Sedation is often offered for comfort.
The skin over the targeted levels is cleaned and numbed with local anesthetic. Additional numbing is delivered along the path of each probe before any heat is applied.
Under fluoroscopy, thin probes are positioned along each medial branch nerve. Each site is heated to a precise temperature for about 60 to 90 seconds — usually multiple sites per side.
You'll rest for 20–30 minutes so we can check your blood pressure and confirm you're moving comfortably. The whole visit usually takes about 60–90 minutes.
Plan to take it easy for a day or two. The skin at the probe sites is usually tender for one to two days, and many patients notice an aching, sometimes burning sensation in the treated area — often called post-procedure neuritis — that can last one to three weeks while the small nerves settle. A small subset of patients have a temporary flare of their original pain during that window. Ice or heat, acetaminophen, and gentle activity all help. We'll talk through what's normal and what's worth a call.
The full benefit of RFA typically isn't felt until four to six weeks out. Once it settles, most patients get six to twelve months of meaningful relief, sometimes longer. The treated nerves do eventually regenerate — that's a normal biological process, not a failure — and when pain returns, the procedure can be repeated. Many patients are on a yearly or every-other-year cycle. RFA isn't permanent, but it can be a durable and reliable way to keep facet pain at bay while you stay active and functional.
The most common after-effect is a temporary pain flare lasting one to two weeks while the nerves settle. Other risks include soreness at the probe sites, small bruising, and rarely, bleeding or infection. A small minority of patients develop persistent numbness or an altered sensation (dysesthesia) in the treated area. Very rare but serious complications — including skin burns at the probe site or injury to a nearby motor nerve — are minimized by image guidance, careful sensory and motor testing before ablation, and meticulous technique.
KeyTone Medical is out of network with all commercial health insurance plans, so this procedure is self-pay, with the cost discussed before anything is scheduled. Many plans reimburse part of the cost of medically necessary care performed out of network — on request we provide a superbill, an itemized and coded receipt, for you to submit to your insurer under your plan's guidelines.
No — not in any way you'll notice in daily life. The nerves we treat are very small sensory nerves that primarily carry pain signals from the facet joints. The skin sensation on your back, your strength, and your ability to feel touch or pressure all stay intact. A small number of patients notice a localized area of altered sensation near the treated sites, which usually fades over weeks to months.
Most patients get six to twelve months of meaningful relief, and some get considerably longer. The treated nerves eventually regrow, which is a normal biological process — when pain returns, that's the signal that it's time to consider repeating.
Yes — and that's a routine part of the plan for many patients. Once the nerves have regenerated and your pain has come back to a level where it's affecting function, the procedure can be done again. Many patients settle into a predictable cycle of one treatment every year or two.
The placement of multiple probes and the heating itself can be uncomfortable, which is why we offer light to moderate sedation for most patients. Local anesthetic is also delivered along each probe path before any heat is applied. Some pressure and a warm sensation are normal during ablation; sharp pain is not, and we'd stop and adjust if you felt that.
Even after clearly positive diagnostic blocks, a positive block doesn't guarantee a durable response, and some patients don't get the relief we hoped for. Sometimes a small accessory nerve branch wasn't fully captured, in which case a targeted repeat can help. Sometimes another pain source — a disc, the SI joint, a deeper muscle pattern — is contributing more than we initially thought. We'd re-examine, review your imaging, and decide together on the next step.
Authoritative references on this topic, for patients who want to read further. These are educational resources, not medical advice.
Educational information only. This page describes radiofrequency ablation in general terms. Whether RFA is appropriate for you depends on your history, exam, imaging, prior diagnostic blocks, and treatment goals. The risks, benefits, alternatives, and expected results will be discussed in detail at your visit.
