Summary of intervention
Radiofrequency denervation, also known as ‘dorsal rhizotomy’ or ‘radiofrequency ablation,’ is a non-surgical and minimally invasive procedure that uses heat to reduce or stop the transmission of pain signals arising from one or more spinal facet joints. It is only recommended when other alternatives have failed.
This guidance applies to adults aged 19 years and over.
Number of interventions 2018/19
Lumbar radiofrequency facet joint denervation (RFD) should only be offered in accordance with NICE Guideline NG59 which recommends it as an adjunct in the management of chronic low back pain only when non-operative treatment has failed, and the main source of pain is thought to arise from one or more degenerate facet joints.
Rationale for recommendation
The facet joints are pairs of joints that stabilise and guide motion in the lumbar spine. These joints are innervated by the medial branches of the dorsal rami. In current clinical practice, suitable patients are first offered one or more diagnostic injections to determine which facet joints are contributing to their symptoms. This particular type of injection is called a ‘medial branch block,’ and differs to facet joint injections, which are no longer recommended by NICE or GIRFT.
Manual therapy, with appropriate psychological therapies where necessary, should be considered as an early intervention to support the individual. Medial branch blocks should be offered only in accordance with the low back pain pathway. Patients who experience a positive response to a medial branch block (i.e. a significant but short term improvement in pain symptoms) may be offered a neurodestructive procedure called radiofrequency denervation in an attempt to achieve longer-term pain relief. Some patients may experience a prolonged response to medial branch blockade such that further interventional treatment is no longer required.
Radiofrequency energy is delivered along an insulated needle in contact with the target nerves. This focussed electrical energy heats and denatures the nerve. This process may allow axons to regenerate with time requiring the repetition of the radiofrequency procedure. Research is ongoing to determine the optimum frequency of repeat radiofrequency denervation.