Lumbar facet radiofrequency ablation (medial branch rhizotomy)

What lumbar facet radiofrequency ablation is

The facet joints are the small joints that connect one vertebra to the next, on either side of the spine. When they wear down or become irritated, they can cause low back pain, especially after standing for a long time, when arching the back, or when getting up from a chair.

Each facet joint gets its sensation from a very fine nerve called the medial branch. Facet radiofrequency ablation — also called rhizotomy or medial branch rhizolysis — applies controlled heat to that sensory nerve to interrupt the pain signal on its way to the brain. The medial branch mainly carries pain sensation from the facet joint and does not control leg strength, so treating it does not take away your strength or your ability to walk.

Let me be clear about this: radiofrequency treats the pain — it does not repair the joint. Whatever arthritis or wear the facet has is still there. What we do is reduce the pain that facet produces, so you can move and go about your life with less discomfort.

Who it is for

This technique is intended for people with chronic low back pain of facet origin that has not improved enough with physical therapy, exercise and medication. It is one option within a broader treatment plan, and the decision is made case by case.

It tends to be a good fit when the pain:

• Sits mainly in the lower back, sometimes radiating to the buttock or thigh, but not below the knee.
• Gets worse when standing, extending the back, or twisting the trunk.
• Improves when sitting or leaning forward.
• Has already been evaluated with a physical exam and, when appropriate, imaging studies.

The diagnostic block first: why I never skip this step

Before performing radiofrequency ablation, I do a diagnostic medial branch block. It involves placing a small amount of local anesthetic precisely on those nerves, under image guidance. If the pain drops markedly during the hours the anesthetic lasts, that confirms the facet joints are the true source of the pain.

This step is the single best predictor of a good result. International guidelines recommend selecting patients with positive diagnostic blocks before offering radiofrequency ablation, because when the right patients are chosen, the odds of relief improve. If the block does not relieve your pain, the pain probably is not coming from the facets, and radiofrequency would not be the answer for you.

What the day of the procedure is like

It is an outpatient procedure: you come in and go home the same day. No hospital stay is required.

• Image guidance. I work under fluoroscopic guidance (or ultrasound, depending on the case) to locate each medial branch precisely. Technical precision matters a great deal in this procedure.
• Anesthesia. Local anesthetic is used on the skin and tissues. In general nothing more is needed; if you are very anxious, we can discuss light sedation. You remain awake and can tell me what you feel.
• The procedure. Through a very fine needle, I place an electrode next to the nerve. Before applying heat, I run a test stimulation to confirm I am in the right spot and away from any motor nerve. The radiofrequency is then applied for a few minutes at each level.
• How long it takes. Between preparation and the procedure itself, plan on about an hour. Afterwards you stay in observation for a short while and then go home, ideally with someone accompanying you.

What to expect afterwards

For the first few days the area may feel sore or tender, like a tight, knotted muscle; this is expected and usually settles with local cold packs and common pain relievers. Relief of the underlying pain is not always immediate: it sometimes builds over the following two to four weeks, as the treated nerve stops transmitting.

When it works, relief typically lasts between six months and a year, sometimes longer. That is because the medial branch can regenerate over time. If the pain returns, radiofrequency ablation can be repeated, and it generally responds much as it did the first time.

I will also give you the other side, without dressing it up: not every patient responds the same way. In well-designed studies (see references), about half of properly selected patients — those with a positive diagnostic block — achieve at least 50% pain relief at six months. That is not a figure that promises a guaranteed result, but it is a real, consistent benefit in well-chosen patients. That is why I insist so much on doing the block first.

My approach is simple: facet radiofrequency ablation is a very useful tool when the pain truly comes from the facet joints and we confirm that first. I do not offer it as a shortcut or as a promise of being pain-free forever. I explain what percentage of people respond, how long relief usually lasts, and that the arthritis does not go away. If, knowing all that, you decide to go ahead, we proceed with every technical detail in place so it goes well.

And something I repeat at every consultation: radiofrequency does not replace exercise or physical therapy. It works best when it opens a window of lower pain that you use to strengthen your back and get moving again. The procedure lowers the pain; movement sustains the result.

Where it is performed: locations in Buenos Aires

I see patients at two locations: Hepta, in San Isidro (Av. Fondo de la Legua 577, Zona Norte) and CIAREC, in Villa Urquiza (Av. Monroe 4770, CABA). At the consultation we assess your case and arrange where and when to do the procedure. I receive patients from across Zona Norte (northern Greater Buenos Aires) and the City of Buenos Aires. Phone: (011) 5895-3260.

Coverage

The diagnostic block and facet radiofrequency ablation are well-established procedures and are usually covered by many private health insurance plans (prepagas) and obras sociales (Argentine health funds), although prior authorization depends on each plan and on the documented indication. From the office we prepare the request and the clinical justification to submit to your insurer. The procedure can also be done on a self-pay basis. We go over the details of each option at the consultation.

When to seek help and next steps

If you have chronic low back pain that you have already tried to treat and it is still limiting you, it is worth finding out where it is coming from. The first step is always a consultation: an exam, a review of your imaging and, if the picture fits, the diagnostic block. Only then do we decide whether radiofrequency ablation is right for you.

I see patients in San Isidro (Hepta) and Villa Urquiza (CIAREC), and I also offer virtual first consultations to point you in the right direction and organize the next steps.

Dr. Mauricio Casarsa

Anesthesiologist. Postgraduate training in Pain Medicine and Interventional Pain Management (UBA — Fundación Dolor; UNLP — CAIDBA). Staff physician at Hospital Alemán de Buenos Aires.

MN 137.756 · San Isidro · Villa Urquiza