It is generally conducted in the outpatient setting, using either local anesthetics or conscious sedation anesthesia.
Two important advantages of RF current (over previously used low frequency AC or pulses of DC) are that it does not directly stimulate nerves and therefore can often be used without the need for general anesthetic, and that it is very specific for treating the desired tissue without significant collateral damage.
Documented benefits have led to RFA becoming widely used during the last 15 years.
RFA procedures are performed under image guidance (such as X-ray screening, CT scan or ultrasound) by an interventional pain specialist
28 patients with low back pain, with a duration, > 6 months and a 50% pain reduction on the numeric analog scale (NAS) after a diagnostic block. All patients received endoscopic facet joint denervation of three facets on the left and right side using only one incision on each side with an exploration of the surrounding tissue. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percentage reduction NAS, subjective assessment of the patient, and duration of the effect.
According to Odom's criteria, 68% of the patients showed “acceptable” to “excellent” results and confirmed that denervation helped them manage their daily lives better. The average pain reduction in the responder group was 47% with an average duration of 7.8 months.
In this retrospective study, Woiciechowsky and Richter from the Vivantes-Humboldt-Klinikum, Spine Clinic, Spine Center Berlin, Charité Medical Faculty Berlin, demonstrated the practicability and effectiveness of the endoscopic facet joint denervation procedure in the treatment of chronic low back pain using only one incision for three facets. Further studies should investigate if this procedure is more effective than percutaneous radiofrequency denervation 1).