Lumbar Radiofrequency Ablation
Lumbar radiofrequency ablation (RFA) is one of the most effective long-duration procedures available for chronic low back pain caused by lumbar facet joint arthritis or degeneration. Unlike steroid injections — which reduce inflammation temporarily — radiofrequency ablation uses heat energy to disable the specific sensory nerves that carry pain signals from the facet joints to the brain. Relief typically lasts 12 to 18 months, and in many cases even longer.
Dr. Edward Rubin performs lumbar RFA under fluoroscopic guidance at certified surgical facilities, ensuring precise nerve targeting and outstanding outcomes.
Who Is a Candidate?
RFA is recommended for patients who:
- Have chronic low back pain from lumbar facet joint disease (facet arthritis, facet syndrome)
- Have had a positive response to diagnostic lumbar medial branch blocks — confirming the facet joints are the pain source
Diagnostic medial branch blocks are the necessary first step. These are small injections of local anesthetic that temporarily numb the nerves serving the facet joints. If your pain is significantly reduced after these blocks, you are a strong candidate for RFA and can expect excellent results.
The Radiofrequency Ablation Procedure
You lie face-down on the procedure table. Under fluoroscopic X-ray guidance, Dr. Rubin places a specialized radiofrequency cannula (needle) precisely alongside the medial branch nerves — the tiny nerves that transmit pain from each facet joint. After confirming correct placement, a gentle electrical current heats the tip of the needle to approximately 80°C (176°F) for 60–90 seconds, creating a small controlled lesion in the nerve.
Multiple nerves are typically treated in a single session (one nerve per facet level, usually treating 2–3 levels). The procedure takes about 45–60 minutes. You are awake but comfortable with local anesthesia; IV sedation can be arranged for anxious patients.
Recovery and Results
- Immediately after: Some soreness and muscle achiness is normal and expected for 1–2 weeks as the tissues heal
- Pain relief onset: Most patients begin noticing improvement 2–4 weeks after the procedure
- Peak benefit: 4–8 weeks post-procedure
- Duration: Typically 12–18 months; some patients report 2+ years of relief
The nerve will eventually regenerate, which is why relief is not permanent. However, when the nerve regrows, the procedure can be repeated with equivalent results.
Advantages of RFA Over Repeated Injections
| Feature | Steroid Injections | Radiofrequency Ablation | |---|---|---| | Duration of relief | 1–6 months | 12–18 months | | Steroid exposure | Yes | None | | Number of procedures per year | Up to 3 | Usually 1 | | Mechanism | Anti-inflammatory | Nerve ablation |
For patients who respond well to injections but find relief too brief, RFA offers a dramatically longer duration without repeated steroid exposure.
Frequently Asked Questions
Will the nerves grow back? Yes — medial branch nerves regenerate over time, typically over 1–2 years. When pain returns, the procedure can be repeated with similar results.
Is there any risk of permanent numbness or weakness? The medial branch nerves are purely sensory and do not control movement. Ablating them does not cause weakness. Some patients notice a small area of mild skin numbness, which is typically not bothersome.
Is the procedure covered by insurance? Medicare and most commercial insurance plans cover lumbar RFA when appropriate documentation — including evidence of prior positive medial branch blocks — is in place. Our office manages prior authorization.
How long is recovery? Most patients return to light activities the next day. Avoid heavy lifting and vigorous activity for 1 week.
Take the Next Step
If you have tried injections and found relief too brief, radiofrequency ablation may be the longer-lasting solution you've been looking for. Call 516-492-3100 or request an appointment below.