Issue 14.14
Arthritis of the spine causes significant pain and decreases the quality of life. Like all arthritic conditions, first line treatment of spine arthritis is physical therapy for core strengthening and oral anti-inflamatories. If these do not provide adequate pain relief, the standard of care is to perform a procedure that “burns out” the arthritis of the spine. It is called Radio Frequency Ablation.
Radio Frequency Ablation or RFA is a treatment covered by Medicare that typically eradicates arthritis pain of the spine. RFA is a technology that uses radio frequency waves to produce heat through specialized needles to specific points of treatment in the body. Cardiologists use the technology to treat cardiac arrhythmias, oncologists use RFA to treat tumors, and interventional spine and pain specialists use the technology to treat common arthritic spine conditions.
In order to see if you are a candidate for a RFA of the spine, you must be seen by an interventional spine specialists or a pain management physician. A thorough history and physical will be performed. Most arthritic conditions of the low back, neck or mid back come from joints called facet joints. These joints can be treated with RFA. Other sites of arthritis of the spine will not likely benefit from RFA. Your physician will determine this based on your evaluation.
Before having RFA, Medicare and most major health insurances require that your pain specialist perform a diagnostic procedure or “test shot” to see if you are likely to have significant pain relief from RFA. This is called a medial branch block or facet nerve block and is done as an outpatient with little or no recovery time. Under x-ray guidance or fluoroscopy, tiny needles are placed next to the arthritic facet joints. Local anesthetic such as lidocaine is injected on the painful arthritic joint. A few minutes later in the recovery area, you will twist, turn and bend to determine what level of pain relief you’ve had. Some patients have 100% pain reduction, others less. Medicare and most health plans require that a patient have at least 50-80% pain reduction in order to be a candidate for RFA.
RFA is then done under conscious sedation as an outpatient procedure. Again fluoroscopy is used to guide the Teflon insulated needles to the facet joints. The heat produced by the RFA waves burn or cauterize the sensory nerves that cause you to feel the joint. The facet joint may regenerate pain sensing nerves a year or two later at which time the procedure can easily be repeated.
Ultimately RFA is a very safe and effective way to “burn” out the arthritis that many patients feel due to the degenerative spine conditions of the back, neck or mid back.
If you would like to be evaluated for RFA, please feel free to call our office, Desert Pain Specialists at 435-216-7000 for a consultation.