Radiofrequency Nerve Ablation
Some patients experience pain from arthritic calcified facets or degenerated chronically inflamed sacroiliac joints. In these patients facet injection and sacroiliac joint injection may give only temporary pain relief. The condition of the spine may be such that the underlying problem cannot be completely fixed. Radiofrequency nerve ablation is a viable option. Radiofrequency nerve ablation is a technique used to heat the medial branch nerve, abnormal facet and sacroiliac joint. The heat actually causes thermal injury to the nerve. Again, one must remember that the cervical, thoracic and lumbar spinal levels have multiple neural innervations. For example, if a physician wants to perform a radiofrequency ablation for an L4 – L5 facet, the nerve from the level above, as well as the level below, must also be ablated. Pain relief from radiofrequency ablation can last anywhere from six months to two years. If performed correctly, radiofrequency ablation offers minimal risk. The thermal lesion is very controllable in size, and the procedure is performed with fluoroscopic guidance. Additionally, prior to thermal ablation, testing occurs to avoid inadvertent motor nerve damage.
Case Study – Right Buttock Pain
An 81-year-old male with Parkinson’s disease presented with severe right buttock pain following a right total-hip arthroplasty. When initially evaluated, the patient’s buttock muscle was almost “rock hard” due to chronic contraction. Treatment began with sacroiliac joint injection and gluteal trigger point injections, and the patient slowly made some improvement. Weightbearing spine films revealed advanced degeneration of the lumbar facets, most likely irritated when the new artificial hip abruptly changed his body mechanics. The patient experienced significant pain relief with lumbar facet injections, as well as with sacroiliac injection; however, relief would only last a day or two. Eventually he underwent radiofrequency nerve ablation in the lower three lumbar facets on the right and in the right sacroiliac joint. The patient reported almost complete relief of his pain.