Thoracic Radiofrequency Ablation (RFA)

  1. What is a thoracic radiofrequency ablation?

    A thoracic radiofrequency ablation (RFA) is an outpatient procedure for treating upper and middle back pain. It is also called thoracic facet thermal coagulation or rhizotomy.

  2. What are thoracic facet joints?

    Facet joints connect the vertebrae, the bones of the spine. They help guide your spine when you move. The upper back area of the spine is called the thoracic region. It contains twelve vertebrae. Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Thoracic facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right T2-3 facet joint, for example, joins the 2nd and 3rd thoracic vertebrae on the right side. Medial branch nerves are found near facet joints. They communicate pain from the facet joints. They tell the brain when a facet joint has been injured.

  3. How do I know if I have thoracic facet pain?

    Thoracic pain may present as muscle tension or as severe pain. Thoracic facet joint pain can occur in an area from your upper back and shoulder down to your hips. If this pain lasts more than two months, you may have thoracic facet pain. Common tests such as x-rays or MRIs may not show if a facet joint is causing pain. The best way to diagnose facet pain is to block the pain signal in the medial branch nerve with a local anesthetic (numbing medication).

  4. What is a thoracic RFA?

    RFA uses radiofrequency energy to disrupt nerve function. When this is done to a thoracic medial branch nerve, the nerve can no longer transmit pain from the injured facet joint.

  5. What happens during an RFA?

    A local anesthetic will be used to numb your skin. Your doctor will then insert a thin needle near the facet joint. Fluoroscopy, a type of x-ray, must be used to position the needle. The doctor will then check to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching and provoke some of your pain. Once the needle is properly placed, the nerve will be numbed. Radiofrequency energy will then be used to disrupt the medial branch nerve. This is often repeated at more than one level of the spine.

  6. What happens after an RFA?

    You will be monitored for up to 30 minutes after the RFA. When you are ready to leave, the staff will give you discharge instructions. Take it easy for the rest of the day. You may feel sore for one to four days. It may be due to muscle and nerve irritation. Your upper back may feel numb, weak, or itchy for a couple weeks. Maximum pain relief normally comes in two or three weeks.

  7. How long can I expect relief?

    Nerves regenerate after an RFA, but how long this takes vary. Your pain may or may not return when the nerve regenerates. It if does occur, another RFA can be done.