RFA- RADIOFREQUENCY ABLATION RFA utilizes electric energy to disperse heat or create a lesion on the nerve that it is placed next to. This will cause denaturization of the protein within the nerve inhibiting the function of the pain nerve. This will prevent the nerve from sending pain signals to the spinal cord and brain. This will provide more long-term relief than when using steroids. Some patients will never need another procedure and for others the RFA will need to be repeated 1-6 years later.
What type of pain is RFA done for?:
Most commonly done on the joints of your spine called the FACET joints. Thus we can help patients with NECK, MIDBACK AND LOW BACK pain by denervating the medial branch nerves at the cervical, thoracic or lumbar facet levels. We can also denervate your SACROILIAC joints. This is done by blocking the sacral lateral branch nerves.
KNEE pain is another common joint problem where we can help by blocking the genicular nerves going to the knee joint. This is done for people with osteoarthritis, but also commonly done for people post total knee joint replacement or after other knee surgeries. Other joints that we can consider denervating are the shoulder, hip and wrist joints.
RFA of the BASIVERTEBRAL NERVE is very new technology for people with LOW BACK PAIN due to VERTEBROGENIC pain.
This pain is due to MODIC or vertebrogenic degenerative endplate/disc changes noted on your MRI. This is becoming a more commonly recognized cause of LOW BACK PAIN.
What are DIAGNOSTIC NERVE blocks?:
These are nerve blocks done on the nerves we are considering doing the RFA on. If these nerve blocks take away most of your pain the day of the procedure, then you are a candidate for the RFA.
Does the RFA procedure hurt?
This procedure typically does not hurt more than any other pain procedure we do as we numb the nerve prior to doing the lesion. If one is concerned, we do offer oral sedation to relax you prior to the procedure. Of course, we numb the skin prior to placing the thin needle to the nerve. This is done with x-ray or ultrasound guidance to ensure we are in the right place. A microelectrode is then placed through the needle. Prior to doing the lesion, we typically do sensory/motor stimulation to again ensure we have the needle tip correctly placed. Then we place the local anesthetic(numbing medicine) on the nerve prior to doing the lesion. We also bathe the nerve with steroid to help prevent post RFA neuritis pain. The radiofrequency current is then sent down the electrode to denervate the nerve.
What can I expect after the RFA?
You will see immediate benefit. However, the final result can take 10-14 days as the denaturization of the protein within the nerve does take some time. You may have some mild tenderness post procedure, that Tylenol or ice (only 20 minutes at a time) may help. Some may require repeat RFA 1-6 years later. The soonest we can do it again is in 6 months.
The sacroiliac joint lies between the hip bones (iliac crests) and the sacrum. The sacrum is triangular shaped and is five fused vertebrae that lies between the lumbar spine and the tailbone (coccyx). The SI joint is supported by many strong ligaments and has very little motion. Thus this joint functions as a shock absorber between the upper body and the legs.
The pain from the SI joint can be from arthritis or dysfunction of the joint due to ligament laxity. In females this often occurs during pregnancy or child birth. However, it is also commonly associated with spine problems above the SI joint such as scoliosis or prior lumbar fusion surgeries. The pain is typically in the low back, buttocks, hip, and may also go to the groin/pelvis or down the legs. One may experience a feeling of leg instability, gait issues or pain when going from sitting to standing. Some may find it painful to sit on the affected side.
There is not a good lab or x-ray to diagnose SI pain or dysfunction. An x-ray may or may not reveal arthritis. Our specially trained providers can help diagnose SI problems by listening to your symptoms, physical examination and reviewing radiological studies.
Patients have typically done NSAID’s, PT or chiropractic prior. Once conservative measures have failed our providers will consider the following treatments:
STEROID injections: are done into the joints with x-ray guidance. RFA Lateral Branch Nerves: will give longer benefit than steroid injections. SI FUSION: if the above are not providing long-term benefit, we will consider fusing your SI JOINT with bone grafts, NO metal hardware. This is a minimally invasive outpatient procedure, meaning you will go home the same day. To be considered for an SI Fusion you will have to have failed conservative treatments above. Insurances require we rule out other sources of pain by checking an MRI or CT of your lumbar spine, SI joints and at least an x-ray of your hip joints. You will also need to have at least 75% improvement with a diagnostic, local anesthetic only injection into your SI joint on the day of the procedure. And yes, insurances require you are successful with 2 diagnostic injections. To learn more go to www.cornerloc.com
These treatments are typically not covered by insurance. If we feel you have ligament laxity, you may see benefit with PROLOTHERAPY. If you have arthritis of your SI joints, you may see benefit with PRP or STEM CELL injections into the SI joints. Talk to our providers to determine what is right for you.
OCCIPITAL HEADACHE TREATMENTS
CAUSES of Occipital HA’s:
These HA’s can be caused by impingement of nerves(see below), upper cervical facet arthritis, muscle trigger points and can be associated with migraine HA’s.
The nerves most commonly associated with Occipital HA’s are not surprisingly called the Occipital Nerves of which there are three: Greater Occipital, Lesser Occipital and the Third Occipital nerves. The Greater Auricular nerve is another not uncommon nerve that may contribute to occipital pain. These nerves traverse across the occipital or lower back area of your skull.
The pain from the upper cervical (neck) facet arthritis, typically C2-3, C3-4 can contribute to occipital pain.
MUSCLE TRIGGER POINTS:
Muscle irritation from tension, prior spine fusion, jaw problems or even shoulder disorders or surgery can contribute to inflammation of the cervical paraspinous muscles.
Not all but some migraine HA’s can be primarily located in the occipital region or begin in the occipital region and spread from there. When this is the case the migraine HA may also be amenable to the following treatments for occipital HA’s, if they have failed the traditional treatments for migraines.
TREATMENTS of Occipital HA’s:
People have typically already failed NSAID’s, Anti-seizure meds, PT, chiropractic care prior to considering below procedures:
STEROID injectons: can be done on the above nerves, facets and muscle trigger points. Our specialized providers do all of these injections with US or x-ray guidance to ensure precise placement of your steroid.
RFA: Radiofrequency Ablation is more commonly done on the nerves that innervate the facet joints of your upper cervical spine. However, this can also be considered for the above-mentioned peripheral nerves. RFA of peripheral nerves may rarely cause a dysesthesia or irritation in that nerve distribution. This is similar to a phantom pain after an amputation. Prior to doing RFA, you will need to have a successful diagnostic nerve block with local anesthetic only.
PNS: Peripheral Nerve Stimulation utilizes new technology that allows us to place tiny electrodes over the above nerves. The below threshold stimulation overrides the pain signals, inhibiting them from getting to the spinal cord or brain. You will first need to show good temporary benefit with a diagnostic nerve block, typically of the greater occipital nerve. You will then also need to do well with a TRIAL PNS prior to having the electrodes permanently IMPLANTED. This is a great feature as it allows you to TEST the success of PNS with only the electrodes being placed under the skin over the nerve and not the remaining wire and receiver with microchip being implanted. The Trial is done with IV sedation. Again, if successful, we proceed to the Implant. The Implant is done with an anesthesia professional to provide deeper sedation. During the Implant a very small incision is made to allow us to have everything under the skin, meaning not only the electrodes, but also the wire housing the microchip. One of the negatives with PNS, is you do need to wear a small antenna placed in an undergarment over the wire to be able to stimulate the receiver microchip.