FEATURE — Arthritis of the spine causes significant pain and decreases the quality of life. Like all arthritic conditions, first line treatment of spine arthritis is physical therapy for core strengthening and oral anti-inflammatories. If these do not provide adequate pain relief, the standard of care is to perform a procedure that “burns out” the arthritis of the spine. It is called radio frequency ablation.
Radio frequency ablation or RFA, is a treatment covered by Medicare that typically eradicates arthritis pain of the spine. RFA is a technology that uses radio frequency waves to produce heat through specialized needles to specific points of treatment in the body. Cardiologists use the technology to treat cardiac arrhythmias, oncologists use RFA to treat tumors, and interventional spine and pain specialists use the technology to treat common arthritic spine conditions.
Candidates must be evaluated by a an interventional spine specialists or a pain management physician, to see if they are ideal for a RFA of the spine. A thorough history and physical will be performed. Most arthritic conditions of the low back, neck or mid back come from joints called facet joints. These joints can be treated with RFA. Other sites of arthritis of the spine will not likely benefit from RFA. Your physician will determine this based on your evaluation.
Before having RFA, Medicare and most major health insurances require that your pain specialist perform a diagnostic procedure or “test shot” to see if you are likely to have significant pain relief from RFA. This is called a medial branch block or facet nerve block and is done as an outpatient with little or no recovery time. Under x-ray guidance or fluoroscopy, tiny needles are placed next to the arthritic facet joints.
Local anesthetic such as lidocaine is injected on the painful arthritic joint. A few minutes later in the recovery area, you will twist, turn and bend to determine what level of pain relief you’ve had. Some patients have 100 percent pain reduction, others less. Medicare and most health plans require that a patient have at least 50-80 percent pain reduction in order to be a candidate for RFA.
RFA is then done under conscious sedation as an outpatient procedure. Again fluoroscopy is used to guide the Teflon insulated needles to the facet joints. The heat produced by the RFA waves burn or cauterize the sensory nerves that cause you to feel pain. The facet joint may regenerate pain sensing nerves a year or two later at which time the procedure can easily be repeated.
Ultimately, RFA is a very safe and effective way to “burn” out the arthritis that many patients feel due to the degenerative spine conditions of the back, neck or mid back.
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Written by Dr. Court Empey for St. George Health & Wellness magazine and St. George News.
Dr. Empey is fellowship trained in interventional pain medicine, completing this training at the world famous Mayo Clinic. A native to St. George, he graduated from both Dixie High School and Dixie College, then completing his Bachelors degree at the
University of Utah in Biochemistry with honors. He was also an honor graduate of the George Washington University where he obtained his Medical Doctorate degree (MD). He then returned to the University of Utah to complete an internship in Internal Medicine and a medical residency in Anesthesiolgy. Lastly, he completed his training in Interventional Pain Medicine at the Mayo Clinic in both Scottsdale, Arizona and Rochester, Minnesota.
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I had this done a few times at Zion Pain Management. At most it lasted a year the last 2 times I had it done it only lasted 6 or 7 months. Seemed to work less and less amounts of time every time I had it done.