Radiofrequency Ablation (RFA)/Rhizotomy
PROCEDURES
Radiofrequency Ablation (RFA)/Rhizotomy
A radio frequency ablation procedure is performed to help manage chronic low back or neck pain which is caused by a condition known as spondylosis. Spondylosis is a common age-related condition that is secondary to degenerative arthritis of the spine. Most people don’t have symptoms, but some may experience pain, stiffness, and muscular spasms.
A medial branch nerve block (MBB) serves as a precursor to determine whether the source of your chronic neck or lower back pain is secondary to arthritis of the facet joints in your spine.
Medial branch nerve supplies the innervation to the facet joint and hence ablating these sensory nerves using heat can help manage the symptoms up to a period of 6 months to 1 year.
Please note: Most commercial insurance companies and Medicare require successful outcomes with 2 sets of diagnostic medial branch nerve blocks to rule out false positive or placebo effect before approving RFA procedure.
In most circumstances, they must be scheduled 2 weeks apart as per payor requirements and protocols.
Please ask Dr. Bhatia any additional questions you may have.
What happens during an injection?
Patient is placed on a fluoroscopy table or an exam table. The site of the injection is identified using x ray machine. The skin and site of injection area are cleaned with antiseptic solution. A grounding pad is applied to your calf/leg. A local anesthetic is used to numb your skin and subcutaneous tissue. The doctor will then insert a thin needle advancing gently towards the target site. X-ray is used throughout to ensure the safe and proper position of the needle. When the needle is confirmed to be in the correct position, the doctor will start sensory stimulation followed by motor stimulation of the nerves to ensure correct needle placement with patient’s feedback. This is not a painful process, rather well tolerated by patients to ensure safety. Then local anesthetic is administered at the target site before ablation process is carried out.
How long does an injection take?
The correct positioning on the table, identification of the injection site and skin preparation with antiseptic solution takes 10 minutes or less. The actual procedure is usually completed in 20 minutes or less. The injection can take slightly longer if your anatomy is challenging due to age, previous surgery, presence of hardware, etc.
Do I need insurance authorization or approval before I can schedule the procedure/injection?
Yes! Every commercial insurance payor and most government advantage programs require preauthorization prior to proceeding with the injections or procedures. We try our very best to get the preauthorization approvals in a timely manner but there are factors that are beyond our control.
Most insurance companies have their own internal teams that reviews these requests on case-by-case basis.
There is a prerequisite checklist that some insurance companies follow, and these can include but not limited to duration of symptoms, modalities trialed, medications trialed, imaging results (MRIs or X rays). We must document this information in an accurate and thorough manner in your office visit note, hence, the first visit with the provider is a consultation visit to start the insurance authorization and approval process.
How do I prepare for the injection and how will I feel afterwards?
Once we obtain insurance authorization, we will schedule you for this procedure based on availability. We request most patients to bring an escort to drive them safely. In most cases, patient feel slight discomfort at the injection site which usually resolves with ice and over the counter medications such as acetaminophen or ibuprofen.
There may be a temporarily sensation of pressure or numbness at the site of the injection. There may also be numbness in your legs from the injection of local anesthetic that usually resolves in few hours. Sometimes we request patients to bring their cane or walker to help them get to their cars safely.
The effect from the RFA procedure can take 4 weeks to demonstrate its maximum benefit. Some patients feel improvement sooner than that.
How much relief can I expect and how long will the relief last?
These are the most difficult questions to answer as outcomes vary from patient to patient. Some patients get excellent relief that can last 6 months to 1 year, and some unfortunately get no relief whatsoever.
There are various factors at play which results in variable outcomes.
These include but not limited to duration of ongoing symptoms, severity of underlying condition, anatomical variations and challenges, previous history of spinal surgery, age, etc.
What about follow up visit?
You will be scheduled for a follow-up visit in 4 weeks after your procedure. At this visit, you and your doctor will discuss the outcome of your previous injection and plan for the next steps based on response.
Please do not hesitate to ask any other questions that you may have. We want you to feel comfortable and at ease knowing that you will always get an honest response!