Radiofrequency Ablation (RFA)

What It Is

Radiofrequency ablation (RFA) — sometimes called radiofrequency neurotomy or facet rhizotomy — uses controlled heat applied through a needle-mounted probe to interrupt the small medial branch nerves that carry pain signals from arthritic facet joints. By disabling those specific pain-carrying fibers, the procedure can give durable relief from facet-mediated back or neck pain.

RFA is offered only after a positive medial branch block has confirmed that those facets are the source of pain. It’s done under live X-ray (fluoroscopy) guidance.

How It Works

A small probe is placed alongside each medial branch nerve under live X-ray. The probe heats a tiny volume of tissue (about the size of a grain of rice) to roughly 80°C for a minute or two, which interrupts the nerve’s ability to carry signals. Because the medial branches are purely sensory and serve only the facet joints, interrupting them doesn’t affect strength or sensation in the leg or arm — just the facet pain.

The nerves slowly regenerate over 6 to 18 months. When pain returns, the procedure can be repeated. Many patients get 12 to 18 months of meaningful relief per cycle.

When It’s Used

RFA is typically considered when:

• Two separate medial branch blocks have each given substantial diagnostic relief, confirming the facets as the pain source
• Conservative treatment (PT, NSAIDs, activity modification) hasn’t given durable relief
• An intra-articular facet injection produced only short-lived relief
• The patient wants months-long relief rather than repeated steroid injections

What to Expect

• The procedure takes 30 to 60 minutes in a fluoroscopy suite at the pain management office or surgery center
• You lie face-down; skin is cleaned and numbed with local anesthetic. Mild sedation is sometimes used.
• Probes are placed at each medial branch under live X-ray. After confirming position, the probe is heated for a brief, controlled burn at each site.
• You can usually drive home the same day unless sedation was given
• Some soreness at the injection sites for a few days is normal
• Pain relief builds over 2 to 4 weeks as the targeted nerves stop functioning, and typically lasts 12 to 18 months

Risks and Limitations

• Soreness at the procedure sites for several days is common and self-limited.
• Skin numbness or a patch of altered sensation can persist; usually mild and not bothersome.
• Infection. Very rare with sterile technique.
• Bleeding / bruising. Relevant if you take blood thinners.
• Recurrence. The nerves regenerate — pain typically returns over 12 to 18 months and the procedure can be repeated.
• Incomplete relief. A subset of patients don’t get the level of relief they hoped for, even after a positive diagnostic block.

Why OSI Doesn’t Do This In-House

OSI does not perform radiofrequency ablation in-house. RFA requires live fluoroscopy, RFA-specific equipment, and dedicated interventional pain training outside the OSI orthopedic scope. Patients who are candidates after positive diagnostic blocks are referred to a trusted pain management physician we work with, with the relevant clinical and procedural records sent ahead.

OSI stays involved on the conservative side — physical therapy, medications, follow-up — so RFA fits into a larger plan and recovery is supported on both ends.

Next Steps

If you think you might be a candidate — or you just want a generalist read on whether this procedure is the right next step — schedule a spine evaluation at OSI or call (830) 625-0009. We will examine you, review imaging you bring with you, and either start a non-operative plan or coordinate the referral to a trusted pain management partner.