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Radiofrequency waves are used to produce heat on specifically identified nerves surrounding the facet joints called the lumbar medial branches of the dorsal ramus of the spinal nerves. [33] By generating heat around the nerve, the nerve is ablated, thus destroying its ability to transmit signals to the brain.
Radiofrequency ablation or lesioning, also known as rhizolysis, can be used to give longer lasting relief by destroying the nerves that supply the facet joint (medial branch nerves). [9] Current guidelines as per the International Spine Intervention Society require two successful medial branch blocks before progressing to a radiofrequency ablation.
Facet joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful muscle spasm.
The fourth criterion clinches the diagnosis: pain relieved by injection of local anesthetic into the correct facet joint. This diagnostic procedure can also be therapeutic; the injection of steroids or radiofrequency denervation of the medial branch can be added for refractory cases.
Facet joint pain: Bogduk was among the first to recognize the role of facet joints as a source of spinal pain and contributed to the literature in anatomy, biomechanics, diagnosis, and therapeutics. He developed diagnostic and therapeutic techniques for facet joint pain, namely medial branch blocks and radiofrequency neurotomy.
Neuroablation can be performed with chemical neurolysis or radiofrequency ablation. These techniques are often used on the medial branch nerves to treat low back pain and have been applied to the superior cluneal nerves. The use of phenol has been noted to relieve pain for up to 9 months but may not completely resolve symptoms. [5]
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