Radiofrequency denervation (or ablation) is a procedure performed as a day case. It is carried out to treat neck or back pain caused by degenerative changes or mechanical strain to the facet joints.

Usually, you will have had diagnostic facet joint injections prior to this procedure. This will have confirmed that the pain is coming from your facet joint nerves. These nerves transmit pain signals from these joints to your spinal cord and, ultimately, your brain.

The aim of the denervation procedure is to heat the tissue and effectively ‘cut’ these nerves resulting in reduced pain transmission. This should give long-lasting relief to the symptoms you are experiencing, but the nerves will regrow over a period of eighteen months to two years.

During the procedure, the nerves are stimulated with a small electric current. This may tingle a little, and the muscles may twitch, although it is not usually painful. You are then sedated whilst the nerves are treated. The whole procedure takes approximately thirty to forty minutes.

Pulsed Radiofrequency is used to desensitise nerve roots that are causing pain due to increased activity. It is a non-destructive technique using high-energy electric fields to reduce target nerves firing and minimise pain transmission.

Pulsed Radiofrequency can be an effective treatment to return the hypersensitive nerve to the state it was in before it began to experience pain, rather like hitting the reset button on a computer.

The delivery of a high-frequency current reduces the ability of the nerve to send pain messages to the brain. It can be an effective treatment following a nerve root block which may have only given short-term benefit.

This procedure may cause a short-term flare-up of pain which then settles after a few days. Occasionally this can last longer, up to a couple of weeks.

Pulsed Radiofrequency treatment is a method for achieving long-lasting pain relief in peripheral nerves using high-frequency pulses of current to desensitise them and block their ability to transmit pain.

This can be an effective treatment for difficult types of pain that often originate from damaged or irritated nerves.

During the procedure, an electrode needle is inserted close to the affected nerve, usually under X-ray Ultrasound or CT guidance. The nerve is then tested, which can produce tingling, twitching or vibrating in the area, which usually gives you pain. Once the correct nerve or branch has been identified, the treatment is then started. This typically takes ten to fifteen minutes.

Local anaesthetic and steroid are injected to help settle the pain and irritation post-operatively.

The vertebrae form the spinal column, extending from your neck to your lower back. The bones are linked at the back by joints called facet joints and discs, which act as shock absorbers. However, these joints can become painful due to wear and tear (degenerative changes), mechanical strain or injury.

Pain from the joints can also spread to other areas, and the muscles near these painful joints can become tight and tender; therefore, pain in the facet joints in the neck can cause headaches and shoulder pain, and pain from lower back facet joints can cause buttock pain and pain down the legs, this is referred pain.

Medial branch blocks or facet joint injections using local anaesthetic and steroid aim to reduce inflammation and pain; they also help confirm a diagnosis.

For many patients, the pain reduces significantly within a few hours of the procedure as a result of the short-acting analgesia. It is important to keep a diary of this and bring it to your follow-up appointment. This usually wears off, and you may have a few days of discomfort. Heat packs or ice packs work well at this time and are particularly useful; paracetamol and Ibuprofen also be used. By the second week, the steroid effect will start calming things down, and you should see a steady daily improvement. However, we advise you to continue your normal daily activity as much as possible.

A therapeutic/diagnostic injection of local anaesthetic and steroid to test the reversibility of pain originating from a non-spinal nerve or joint and consists of two separate components. Firstly, the local anaesthetic will freeze the area, making it numb. This can last for several hours, and there is an indication of the reversibility of the pain, helping to confirm the diagnosis. 

The second Component is a corticosteroid that helps treat any associated inflammation and, where present, can lead to several weeks or months of pain relief.

Piriformis syndrome is a cause of buttock leg pain. It can occur spontaneously or as a result of an injury. The muscles in the buttock can feel tight and tender, which can cause a deep pain which may radiate upwards into the lower back or downwards into the back of the leg.

Treatment for Piriformis Syndrome includes Physiotherapy, Medication (muscle relaxants, analgesics, anti-inflammatories) and local anaesthetic and steroid injections. In particularly persistent cases, Botox injections may be advised to reduce spasm in the Piriformis muscle.

Where injections are indicated, you will come to the hospital as a day case. You will be asked to lie face down. The needles are placed into the Piriformis muscle under X-ray or Ultrasound guidance. Dye is injected to outline the muscle. Local anaesthetic and steroid are then injected. This will help reduce the inflammation and swelling around the nerves that pass through and near the Piriformis muscle.

Lidocaine Infusion

Lidocaine is a type of drug that reduces impulses from the group called local anaesthetics. It is used to calm down nerve-related pain, which may affect the whole body or just part of it only when medicines taken by mouth are not helping your pain.

This is carried out as a day case procedure in hospital, and Dr Evans will have gone through the rationale for this treatment with you in clinic prior to your admission.