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Lumbar Medial Branch RF Neurotomy

If your doctor determines that facet joints in your lower back (lumbar spine) are causing your low back, buttock, thigh, or leg pain, your doctor may recommend lumbar medial branch radiofrequency neurotomy (RF neurotomy) for long-term pain relief. This procedure can have several names, including:

  • RF neurotomy
  • Rhizotomy
  • RF ablation

The goal of RF neurotomy is to block the medial branch nerves from sending pain signals from the lumbar facet joints to the brain. If the nerves’ pain signals are blocked, your pain may be reduced.

How RF neurotomy works

The RF neurotomy procedure uses a small, controlled amount of radiofrequency energy to heat the medial branch nerve. If the nerve is heated for a certain length of time, it will lose the ability to send pain signals.

This procedure may decrease pain from the facet joints on a long-term basis. Pain relief varies from person to person. The pain relief can be as short as six months or can last several years. Typically, the relief lasts for 10 to 16 months.

Overview of the lumbar RF neurotomy procedure

Here’s what to expect during a lumbar RF neurotomy procedure:

  • Before the procedure, you’ll get an intravenous (IV) line placed in your arm, so you can receive fluids and medicine during the procedure.
  • You will lie face down with a pillow underneath your abdomen.
  • The injection area is cleaned and numbed before the injection.
  • Using fluoroscopic (X-ray) guidance, your physician will insert and advance needles to the medial branch nerves. These needles have tips that allow heat to be transferred to the medial branch nerves.
  • Your doctor may then do some motor testing, during which you may feel some twitching of the muscles in your back.
  • Next, your doctor will inject a small amount of numbing medication near the nerve to make the procedure more comfortable for you.
  • Next, your doctor will heat the medial branch nerves at a specific temperature for at least one minute.
  • Your doctor will repeat the process with other locations around the nerve as needed.
  • In some cases, your doctor will inject a small amount of steroid and anesthetic to reduce inflammation from the procedure.
  • After the procedure, you’ll spend at least 30 minutes in the recovery area.

Preparing for lumbar RF neurotomy

  • While the procedure may take less than 30 minutes, you should allow for at least one to two hours at the procedure center.
  • You need to arrange for a driver to be present and take you to and from the medical facility. If you do not have a driver with you, we may have to reschedule your procedure.
  • Tell your doctor, nurse, or care coordinator if you have a pacemaker or defibrillator.
  • If you develop a fever, night sweats, or an active infection before your procedure, your procedure will need to be rescheduled. Please contact our office at (651) 968–5201 immediately to let us know about the symptoms you’re experiencing.
  • If you are placed on antibiotics before your procedure, please contact us right away. We may need to reschedule your procedure.

After the injection

  • Follow the specific instructions given to you by the nurses at the procedure center.
  • Plan to rest for one to two days after the procedure. You may resume light activity that is comfortable for you, but do not overexert yourself the first couple of days.
  • Keep the skin puncture sites clean and dry. Remove any bandages the next day and keep the skin open to air.
  • For discomfort, apply ice packs to the injection site for 15 minutes several times a day.
  • Do not soak in a tub for 24 hours after the procedure. You may take showers.
  • After the first 24 hours, you may soak in a warm tub or stand under a warm shower two or three times per day to soothe the area. After each soak, pat the skin dry with a clean towel.
  • Report any signs of infection or other unusual symptoms to our office, including:
    • Redness and warmth at the injection site
    • Increasing pain
    • Swelling or drainage at the injection site
    • Chills, night sweats, or fever that reaches above 100° F
  • Keep a record of your pain and symptoms after the injection and report your results as instructed by your doctor’s patient care coordinator.

Remember, you may have discomfort for a few weeks after the procedure. This discomfort should gradually disappear as you heal. After the procedure soreness is gone and you begin to resume normal activity, you will be able to evaluate the improvement in your pain. It may take up to six weeks to get full pain relief benefits from RF neurotomy.

Potential risks of RF neurotomy

The risks of RF neurotomy are minimal and are similar to any procedure involving a needle placement. These include, but are not limited to:

  • Allergic reaction. Be sure to inform us before the injection if you have any known allergies
  • Bleeding
  • Infection
  • Irritation of the injected area, which could cause temporary worsening pain

If your procedure includes sedation

  • You should have no solid foods for six hours before your procedure.
  • You may have clear liquids up to two hours before your procedure. Examples include:
    • Water
    • Broth
    • Clear fruit juices such as apple, cranberry, and grape juice (no pulp)
    • Tea, black coffee with no cream
    • Carbonated beverages
  • Nothing by mouth, including throat lozenges, mints, and all hard candy, for two hours before your procedure.
  • No gum for two hours before your procedure.
  • You must have a responsible adult arrive with you to our facility and drive you home. If you use a taxi or volunteer ride service, you still must have a responsible adult with you in order to help take care of you after your procedure.
  • Please take your regular medications the day of your procedure, especially any heart, diabetes, or blood pressure medications.

Summit Orthopedics offers comprehensive spine expertise

Summit’s spine care team is recognized by the National Committee for Quality Assurance for the comprehensive expertise of our patient-centered care. Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.

Start your journey to a healthy spine. Find your spine expert, request an appointment online, or call us at (651) 968–5201 to schedule a spine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNVadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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