Radiofrequency Neurotomy

Introduction

• Alternating current of high frequency radio waves
• Ion movement creates friction, dissipates energy as heat.
• Heating nerve tissue >45 degrees causes neural blockade
• Heating to 60-100 degrees induces protein coagulation and cell death
• Conventional RF lesion done at 80-85 degrees for 60-90 seconds
• Needle placement (for blocks and RF) confirmed normally by fluoroscopy +/- sensory and motor testing for RF
• Pain often recurs after ~400 days but can be repeated

Indications

Generally for nociceptive pain: shut off nociceptive afferents from the painful structure (but not selective). Diagnosis should be confirmed with two positive diagnostic blocks. A single positive block can have a high false positive due to the placebo effect. RF is not indicated for central pain, spinal cord pathology, serious psychological factors, or when confident pain ratings are not possible.