Adjuvant Thermal Radiofrequency Treatment
Thermal radiofrequency denervation (RFD) is an established, minimally invasive procedure for treating chronic lumbar back pain when it is caused by the facet joints. At ISSZ, we regularly use this treatment, and I would like to briefly outline the indication, prerequisites, procedure, and prospects of success.
Indication – Who is this method suitable for?
RFD is recommended for patients with chronic lumbar back pain lasting 3 months or more who have not responded adequately to conservative treatments and meet specific criteria.
There should be no radicular symptoms or specific underlying causes such as fractures, tumors, or infections. Facet joints are considered the source of pain in up to 40 percent of cases; however, clinical findings and imaging do not allow for a reliable diagnosis.
Diagnostics – Medial Branch Blocks (MBB) as the Gold Standard
For diagnostic confirmation, medial branch blocks (MBB) are essential. These should be performed under imaging guidance (fluoroscopy/C-arm or CT) using a low injection volume (0.5 ml) to avoid nonspecific spread. A diagnostic block is considered positive with ≥ 50% pain reduction, which is sufficient for routine clinical practice.
According to international guidelines, a double block is generally recommended to minimize false positives. In research settings or particularly selective clinical cases, a higher threshold of ≥ 80% pain reduction and mandatory double blocks are required.
Technical Procedure of Thermal Radiofrequency
The effectiveness of RFD largely depends on a standardized technique. Guidelines recommend the following:
- Thermal lesions at 75–90 °C for 90–120 seconds
- Use of ≥ 18G cannulas with a 10 mm active tip
- Multiple lesions per medial branch to achieve complete denervation
- Mandatory sensory and motor stimulation to confirm correct needle positioning
- Restrictive use of sedation: diagnostic blocks are performed without sedation, and RFD only with light, conscious sedation if necessary
Effectiveness and Expected Course
When correctly selected, patients can experience significant pain relief and functional improvement from RFD for a duration of 6–12 months, with effects in some cases lasting even longer. If pain recurs, the procedure may be repeated—provided that the initial RFD was successful.
Aftercare – RFD is not a stand-alone therapy!
Radiofrequency denervation is not a stand-alone therapy but should be understood as one component of a multimodal treatment approach. Following the intervention, the pain relief achieved should be consistently used to enable and support active physiotherapy, exercise therapy, and educational measures aimed at improving functionality, mobility, and resilience.
Safety
RFD is generally considered a safe procedure with a very low rate of serious complications. Most commonly, patients may experience only temporary local pain or dysesthesia.
Rare risks such as infections or neuropathic symptoms can be minimized through consistent use of imaging guidance, strict aseptic technique, and electrophysiological monitoring.
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