Overview
Radiofrequency ablation (RFA) — also called radiofrequency neurotomy or rhizotomy — uses radiofrequency energy to heat and ablate (deactivate) the small nerves that transmit pain signals from spinal facet joints or the sacroiliac joint. Unlike injections that provide temporary anti-inflammatory relief, RFA interrupts pain transmission at the neural level — providing significantly longer-lasting relief, typically 12–18 months or more, until the nerves regenerate. RFA is one of the most durable non-surgical treatments available for facet-mediated back and neck pain and sacroiliac joint pain. Dr. Migdale performs RFA under fluoroscopic guidance following positive diagnostic medial branch blocks or lateral branch blocks.
How Radiofrequency Ablation Works
RFA uses a specialized needle electrode placed adjacent to the target nerve under fluoroscopic guidance. The electrode tip is heated to 80–90°C for 60–90 seconds, creating a controlled thermal lesion that interrupts pain signal transmission in that nerve. The procedure is performed under local anesthesia with mild sedation in an ambulatory surgery center setting. Because the medial branch nerves are purely sensory (carrying no motor function), ablating them does not cause muscle weakness — it simply interrupts the facet joint's pain signal.
Cooled RFA for SI Joint Pain
Standard RFA uses a single active electrode tip. Cooled radiofrequency ablation (CRFA) uses water-cooling within the probe to allow higher energy delivery, creating a larger, more spherical lesion — ideal for the anatomically complex lateral branch nerves supplying the sacroiliac joint. CRFA of the lateral branches is the most evidence-supported treatment for long-term SI joint pain relief, with studies showing meaningful relief for 12 months or more in the majority of responders.
Recovery and Results
Most patients experience a post-procedural soreness period of 1–3 weeks as the treated area recovers. Full benefit is typically realized 4–6 weeks after the procedure, once the initial inflammatory response subsides. Pain relief typically lasts 12–24 months. When the nerves regenerate (which they will), the procedure can be repeated — and many patients find that repeat RFA produces equivalent or better results.