A treatment for back or neck pain coming from the facet joints — the small paired joints at the back of each spinal level. Each joint is supplied by tiny nerves whose only job is carrying pain from it, and those nerves can be interrupted with heat delivered through a needle. No incision, no implant, and nothing is removed.
Each level of the spine is joined to the next in three places: the disc at the front, and a pair of small facet joints at the back. Those joints carry load, guide how the spine bends, and wear out like any other joint — and when they do, they hurt.
The useful anatomical fact is how their sensation is carried. Each facet joint is supplied by medial branch nerves, and these nerves do almost nothing else. They do not move a muscle you would miss, and they do not carry sensation from your skin or your leg. If the joint is the source of the pain, interrupting them interrupts the pain and takes very little else with it.
Radiofrequency ablation does that with heat. A fine insulated needle is placed alongside the nerve under X-ray guidance, and a current at its tip warms the surrounding tissue enough to stop the nerve conducting.
Medial branch anatomy and probe placement. Posterior oblique view of a lumbar level showing the facet joint, the medial branch nerve crossing the junction of the transverse and superior articular processes, and the radiofrequency cannula positioned parallel to the nerve.
Facet joints look worn on almost everybody’s scan past middle age, and most of that wear is not causing pain. So imaging cannot tell you whether these joints are the source — it can only tell you they are candidates. Ablating on the strength of a scan is how this procedure gets a reputation for not working.
What can tell you is a medial branch block. The same nerves are bathed in local anaesthetic, using the same X-ray guidance and the same targets. It is a test, not a treatment:
Local anaesthetic is placed on the medial branches supplying the suspected joints. It wears off within hours — the point is not lasting relief.
You are asked to note how much your usual pain changed and for how long, and to test it by doing something that normally hurts. A pain diary sounds fussy and is the actual result of the test.
Substantial temporary relief means the nerves that were numbed were carrying the pain — and interrupting them for longer is likely to help. Little or no relief means they were not, and ablation would not have worked either.
A second confirmatory block is common, and is required by many insurers before ablation is authorised. It guards against a placebo response on a single occasion.
A negative block is a useful result, not a wasted procedure — it redirects the search rather than leaving an ineffective treatment to do it.
Facet-mediated pain has a fairly consistent pattern, and it is close to the opposite of the disc and nerve-root patterns described elsewhere on this site.
Referred pain into the buttock or the back of the thigh is common, and into the shoulder or the back of the head from the neck. What facet pain does not usually do is run below the knee or into the hand in the pattern of a single nerve — that points to a root instead.
The last one matters most. Radiofrequency ablation treats a pain signal; it does nothing about pressure on a nerve or on the spinal cord. Where there is weakness, numbness or a compressed cord, the problem is the compression and the answer is elsewhere on this site.
Tell the team about any implanted cardiac device before scheduling. Radiofrequency current and pacemakers or defibrillators interact, and this is managed with straightforward precautions when it is known about in advance.
You lie face down and the area is cleaned and numbed. The procedure is done under live X-ray guidance; sedation is available but you stay responsive enough to answer questions during testing.
Insulated needles are advanced to the bony landmark each medial branch crosses. They are laid as nearly parallel to the nerve as the anatomy allows — the heated zone forms along the side of the tip rather than beyond it, so a needle placed across the nerve may miss it.
Stimulation through the needle confirms the position twice over: a sensory test reproduces your familiar pain, and a motor test checks that nothing supplying a limb is nearby. Placement is adjusted until both are right.
Local anaesthetic is given through the needle, then the tip is heated for roughly a minute to two per site. Each targeted joint needs two nerves treated, because every facet joint is supplied from the level above as well as its own.
The needles come out, a dressing goes on, and you are observed briefly. Most people are driven home within the hour and back to ordinary activity the following day.
Medial branch radiofrequency ablation. Cannula placement along the medial branch under fluoroscopy, sensory and motor testing, and the lesion forming along the length of the active tip.
Ablation behaves differently from an injection, and the differences surprise people who are expecting one.
What ablation does not do is change the joint. The arthritis is still there; what has been interrupted is its ability to report. That is a reasonable trade when the joint is genuinely the source, and it is why the diagnostic block matters so much.
This practice performs three needle-based procedures for spinal pain, and they aim at three different structures. Which one applies depends entirely on where the pain is coming from.
More than one can apply to the same patient, and the sequence is worked out from examination, imaging and where appropriate diagnostic blocks.
Figures are general ranges from the published literature, not guarantees for any individual case. Reported success rates vary considerably between studies, and much of that variation comes down to how carefully patients were selected with diagnostic blocks beforehand. Temporary numbness over the skin of the treated area and a few days of soreness are common; serious complications are rare.
It is a question answered by examination and by a diagnostic block, not by a scan alone. Bring any MRI or CT you already have, and a sense of what makes the pain better and worse — that history does more work here than the imaging does.