Thoracic radiofrequency ablation is a nonsurgical procedure used in destroying nerve fiber that transmits pain from the thoracic region to the brain.
This procedure is done after a patient has undergone a successful thoracic medial branch block and the nerve transmitting the pain is detected.
The thoracic region is the section of the spine that is between the neck and the lower back. It contains 12 vertebrae and the facet joints connect each vertebra with each other.
Medial branch nerves are found close to the facet joints and they transmit signals, sensation, and pain from the facet joint to the brain.
If the facet joint is injured, the medial brain nerve will transmit the pain signals to the brain. The nerves inform the brain of the injury; hence the patient starts to feel pain.
Using the thoracic radiofrequency ablation, the doctor uses radiofrequency waves to stop the nerve from transmitting the pain signal to the brain.
The radiofrequency waves burn the nerve which is transmitting the pain to the brain, thereby cutting off the link to the brain. This stops the pain from being felt by the patient.
What is Thoracic facet joint pain?
Thoracic facet joint pain is a pain you feel in the thoracic facet joint region. The pain you feel between your neck and your lower back can be as a result of thoracic facet joint injury. You may feel tension in your muscle, mild or severe pains.
Pain may be as a result of an injury in the cartilage inside the facet joint or ligaments that connects the joints. You may feel pain around your neck, upper back or shoulder. All these may be signs that you have thoracic facet joint pain.
Who is the right candidate for thoracic radiofrequency ablation?
To be eligible for thoracic radiofrequency ablation, you first need to undergo a successful thoracic medial branch nerve block.
The medial branch nerve block procedure will first be used to discover the nerve that is responsible for pain transmission.
If the nerve is discovered and the pain is successfully blocked, the doctor will then know the source of the pain for a more permanent solution, which is the radiofrequency ablation.
If after the medial branch nerve block is done but the pain is not successfully blocked, then you are not a right candidate for thoracic radiofrequency ablation.
Other criteria include:
- You should not have an infection
- You should not have a bleeding problem
- You should not be allergic to any of the medication or anesthetic that will be used.
- You should not be on a blood-thinning medication.
- Pregnant women are not allowed to undergo the procedure.
What to do before the procedure?
Your doctor will ask you some medical questions and your medical history. If you are on any medication such as blood-thinning medication or you are taking aspirin, you will need to stop taking them days before the procedure.
In case you have any allergies, you need to tell your doctor about the allergies. You are not allowed to eat or drink anything before the procedure for at least 6 hours before the commencement of the treatment.
You should make arrangement for somebody that is going to drive you back home because you are not allowed to drive after the procedure.
How the procedure is done?
At the start of the treatment, you will be asked to lie down on an X-ray table. You will be given local anesthetic at the injection site so as to numb the area and to reduce pains and discomfort.
You are meant to stay awake during the treatment so that you can inform your doctor of what you feel at any time.
With the help of a fluoroscope, the doctor will then direct a tiny hollow needle into the area where you are feeling the pain.
The doctor uses the fluoroscope to see the direction of the needle and to direct the needle to the right spot. Contrast dye may as well be injected into the area so that the doctor can see the location of the needle more clearly.
After the needle has been inserted into the right spot, a numbing medication or anesthetic is injected into the area. A tiny electrode is inserted into the hollow needle and the doctor then passes radiofrequency waves through the needle.
The waves burn and destroy the nerve which is transmitting the pain signal to the brain. When the nerve is burnt, the transmission is stopped and the pain is no longer felt.
It takes about 90 seconds for each nerve to be burnt and multiple nerves can also be burnt at the same time.
Thoracic radiofrequency ablation takes between 15-45 minutes to be completed.
After the procedure
After the treatment is completed, you will be taken to a recovery area where you will be monitored and observed.
The result of the residual effects of the nerve burn may cause you to feel pains for some days after the procedure.
This is entirely normal and the pain can be relieved by taking pain killers medicines. In case there are swelling in the area where the needle was inserted, applying ice packs help to reduce the swelling.
You will be allowed to go back home after a few hours but someone will need to drive you home.
You can resume work or normal daily activities after 24 hours.
Successful radiofrequency ablation may relief you of pain for six months to over 2 years. The pain may return when the nerve that was destroyed starts to grow again. In cases like this, the procedure will need to be repeated again.
Potential Risks and Complications
Thoracic radiofrequency ablation is a relatively safe procedure, however, just like every other medical procedure, there are some potential risks or complications that may occur. These include:
- Allergic reactions to medications that were used for the procedure
- Neuritis neuroma
- Temporary increase in nerve pain
- Localized numbness
- Damage to the surrounding blood vessels and nerves during needle injection which can result in excessive bleeding.