Thoracic Facet Radiofrequency Neurotomy overview

Longer-lasting treatment for sacro-iliac joint pain

Thoracic radiofrequency neurotomy (RFN) is a procedure used to relieve pain in the middle section of the back arising from the facet joints. The term ‘neurotomy’ refers to a medical procedure that modifies the function of a nerve.

The technique uses radio waves to generate heat at around 85°C. This heat is applied through a thin needle to a very small area of nerve tissue, preventing the nerve from transmitting pain signals to the spinal cord and brain without completely destroying it.

In many cases, radiofrequency neurotomy may provide longer-lasting pain relief than treatments such as nerve blocks and other injections.

The procedure is generally preceded by a diagnostic nerve block to determine whether a specific nerve is responsible for the pain. If the nerve block produces a significant reduction in pain, radiofrequency neurotomy may be recommended as a longer-lasting treatment.

Radiofrequency neurotomy is also known as radiofrequency ablation, radiofrequency denervation, radiofrequency lesioning, radiofrequency rhizolysis or radiofrequency rhizotomy. These terms describe the same procedure.

After treatment, the nerve tissue slowly regenerates over a period of approximately six months to two years. If the pain returns, the procedure may need to be repeated. Around 60% of people who undergo the procedure report pain relief lasting for one year or more.

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Thoracic facet radiofrequency neurotomy indications and preparation

Preparing for thoracic radiofrequency neurotomy

Thoracic facet radiofrequency neurotomy may be recommended for:

  • Facet joint syndrome.
  • Mid or upper back pain.
  • Pain following previous spinal surgery.
  • Spondylosis.
  • Arthritis, particularly osteoarthritis affecting the thoracic facet joints.

You should avoid undergoing any other medical procedures, such as dental treatment or a colonoscopy, within 48 hours before or after the procedure.

You should also:

  • Not eat or drink anything during the 6 hours immediately before the procedure. Regular medication may be taken with small sips of water.
  • Not take diabetes medication until after the procedure.
  • Not drive yourself to or from the appointment.

Please let us know ahead of the procedure if:

  • You are taking any antibiotics.
  • You have a pacemaker or defibrillator.
  • You are ill, in which case we may need to postpone the procedure.

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Thoracic facet radiofrequency neurotomy procedure

What to expect during your procedure

The procedure uses fluoroscopic X-ray guidance and radiofrequency energy to accurately target the nerve responsible for transmitting pain signals.

1. Positioning and anaesthetic

You will lie face down on a fluoroscopy table while an IV line is placed to administer a light anaesthetic. You will remain awake during the procedure.

2. Injection site preparation

The injection area is cleaned and numbed with local anaesthetic before a thin needle is inserted.

3. Fluoroscopy-guided placement

The needle is guided into the correct position using real-time X-ray imaging.

4. Nerve stimulation test

A small electrical current is passed through the needle to confirm its position. This may cause brief pain and some muscle twitching in the back or neck.

5. Local anaesthetic injection

Local anaesthetic is injected through the needle to numb the targeted nerve.

6. Radiofrequency treatment

Once the nerve is numb, radiofrequency energy heats the needle and blocks the nerve from transmitting pain signals.

After your Thoracic facet radiofrequency neurotomy

Recovery and activity after the procedure

After the procedure you are able to return home. There is no restriction on day-to-day activities, although, as advised above, due to the sedation you should not drive a vehicle for at least 24 hours after the procedure (so it is a good idea to have someone drive you to and from the appointment).

In some cases, there may be some pain or discomfort (sometimes a sensation similar to sunburn) and/or bruising to the skin at the injection site, which may last for about a week.

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Thoracic facet radiofrequency neurotomy risks

Possible complications to be aware of

A thoracic facet radiofrequency neurotomy is a relatively low risk procedure, however all medical treatment comes with some level of risk. If you experience severe pain or weakness, or your temperature is over 38C, you should let us know urgently or visit the nearest emergency department. Possible complications may include:

Bleeding

Minor bleeding may occur around the insertion site.

Infection

A small risk of infection is present.

Pain at injection site

Temporary soreness or discomfort may occur after the procedure.

Allergic reaction

A reaction to the anaesthetic or contrast dye may occur.

Damage to the lung lining

Rarely, the lining of the lung may be inadvertently affected.

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  • Comprehensive pain assessments
  • Individual treatment planning
  • Medication review and optimisation

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