Radiofrequency Ablation

  • Chase A. Kissling
  • David Provenzano
  • Steven P. Cohen
  • Eric T. Lee


Radiofrequency ablation (RFA) has been around for the last four decades and is being used with increasing frequency to address recalcitrant axial spine and more recently treatment-resistant knee pain. Evidence for various treatment sites is variable and ongoing, but the majority of research suggests an overall benefit for the use of RFA for patients who have been appropriately selected based on history, physical, and relative confirmation of the source with relief following diagnostic blocks.


Radiofrequency ablation RFA Sacroiliac Lumbar Cervical Knee Genicular Axial spine Intervention Facet 

Recommended Reading

  1. 1.
    Bhatia A, et al. Radiofrequency procedures to relieve chronic knee pain an evidence-based narrative review. Reg Anesth Pain Med. 2016;41:501–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Bogduk N. International spine intervention society practice guideline for spinal diagnostic and treatment procedures. 2nd ed. San Francisco: International Spine Intervention Society; 2013.Google Scholar
  3. 3.
    Bogduk N, Macintosh J, Marsland A. Technical limitations to the efficacy of radiofrequency neurotomy for spinal pain. Neurosurgery. 1987;20(4):529–35.PubMedCrossRefGoogle Scholar
  4. 4.
    Bogduk N, Dreyfuss P, Govind J. A narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Med. 2009;10(6):1035–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Burnham RS, Yasui Y. An alternate method of radiofrequency neurotomy of the sacroiliac joint: a pilot study of the effect on pain, function, and satisfaction. Reg Anesth Pain Med. 2007;32(1):12–9.PubMedGoogle Scholar
  6. 6.
    Choi WJ. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152:481–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Cohen SP, Hurley RW, Buckenmaier CC, Kurihara C, Morlando B, Dragovich A. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008;109(2):279–88.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Cosman ER Jr, Gonzalez CD. Bipolar radiofrequency lesion geometry: implications for palisade treatment of sacroiliac joint pain. Pain Pract. 2011;11(1):3–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Cosman ER Jr, et al. Factors that affect radiofrequency heat lesion size. Pain Med. 2014;15:2020–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Engel A, et al. The effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy: a systematic review with comprehensive analysis of the published data. Pain Med. 2016;17:658–69.PubMedGoogle Scholar
  11. 11.
    Falco FJ, et al. Systematic review of the therapeutic effectiveness of cervical facet joint interventions: an update. Pain Physician. 2012;15(6):E839–68.PubMedGoogle Scholar
  12. 12.
    Ferrante FM, King LF, Roche EA, Kim PS, Aranda M, Delaney LR, Mardini IA, Mannes AJ. Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med. 2001;26(2):137–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Franco CD, et al. Innervation of the anterior capsule of the human knee: implications for radiofrequency ablation. Reg Anesth Pain Med. 2015;40(4):363–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Gallagher J, Petriccione dVP, Wedley J, Hamman W, Ryan P, Chikanza I, Kirkman B, Price R, Watson M, Grahame R, Wood S. Radiofrequency facet joint denervation in the treatment of low back pain: a prospective-controlled double-blind study to assess its efficacy. Pain Clin. 1994;7:193.Google Scholar
  15. 15.
    Gupta A, et al. Comparative effectiveness review of cooled versus pulsed radiofrequency ablation for the treatment of knee osteoarthritis: a systematic review. Pain Physician. 2017;20(3):155–71.PubMedGoogle Scholar
  16. 16.
    Haemmerich D. Biophysics of radiofrequency ablation. Crit Rev Biomed Eng. 2010;38(1):53–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Iannaccone F, et al. A review of long-term pain relief after genicular nerve radiofrequency ablation in chronic knee osteoarthritis. Pain Physician. 2017;20(3):E437–44.PubMedGoogle Scholar
  18. 18.
    Ikeuchi M, Ushida T, Izumi M, Tani T. Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees. Pain Med. 2011;12:546–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Juch JN, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain-the mint randomized clinical trials. JAMA. 2017;318(1):68–81.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Kornick C, Kramarich SS, Lamer TJ, Sitzman TB. Complications of lumbar facet radiofrequency denervation. Spine. 2004;29(12):1352–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med. 2004;5(3):289–98.PubMedCrossRefGoogle Scholar
  22. 22.
    Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine. 2001;26(13):1411–6; discussion 1417.PubMedCrossRefGoogle Scholar
  23. 23.
    Lee C-H, et al. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Lord SM, Bogduk N. Radiofrequency procedures in chronic pain. Best Pract Res Clin Anaesthesiol. 2002;16(4):597–617.PubMedCrossRefGoogle Scholar
  25. 25.
    Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Lord SM, et al. Percutaneous radiofrequency neurotomy of the cervical medial branches: a validated treatment for cervical zygapophysial joint pain. Neurosurg Q. 1998a;8(4):288–308.CrossRefGoogle Scholar
  27. 27.
    Lord SM, McDonald GJ, Bogduk N. Percutaneous radiofrequency neurotomy of the cervical medial branches: a validated treatment for cervical zygapophysial joint pain. Neurosurg Q. 1998b;8(4):288–304.CrossRefGoogle Scholar
  28. 28.
    Macvicar J, et al. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012;13:647–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine. 2008;33(12):1291–7; discussion 1298.PubMedCrossRefGoogle Scholar
  30. 30.
    Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol. 1976;39(2):69–76.PubMedGoogle Scholar
  31. 31.
    Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012;13(3):383–98.PubMedCrossRefGoogle Scholar
  32. 32.
    Pineda SM, et al. Analgesic effect and functional improvement caused by radiofrequency treatment of genicular nerves in patients with advanced osteoarthritis of the knee until 1 year following treatment. Reg Anesth Pain Med. 2017;42(1):62–8.CrossRefGoogle Scholar
  33. 33.
    Pino CA, Hoeft MA, Hofsess C, Rathmell JP. Morphologic analysis of bipolar radiofrequency lesions: implications for treatment of the sacroiliac joint. Reg Anesth Pain Med. 2005;30(4):335–8.PubMedGoogle Scholar
  34. 34.
    Poetscher AW, et al. Radiofrequency denervation for facet joint low back pain. A systematic review. Spine. 2014;39:E842–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Provenzano DA, Lassila HC, Somers D. The effect of fluid injection on lesion size during radiofrequency treatment. Reg Anesth Pain Med. 2010;35(4):338–42.PubMedCrossRefGoogle Scholar
  36. 36.
    Provenzano DA, Lutton EM, Somers DL. The effects of fluid injection on lesion size during bipolar radiofrequency treatment. Reg Anesth Pain Med. 2012;37(3):267–76.PubMedCrossRefGoogle Scholar
  37. 37.
    Provenzano DA, Liebert MA, Somers DL. Increasing the NaCl concentration of the preinjected solution enhances monopolar radiofrequency lesion size. Reg Anesth Pain Med. 2013;38(2):112–23.PubMedCrossRefGoogle Scholar
  38. 38.
    Provenzano D, et al. The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size. Reg Anesth Pain Med. 2015;40(2):112–24.PubMedCrossRefGoogle Scholar
  39. 39.
    Rambaransingh B, Stanford G, Burnham R. The effect of repeated zygapophysial joint radiofrequency neurotomy on pain, disability, and improvement duration. Pain Med. 2010;11:1343–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Roberts S, et al. Cadaveric study of sacroiliac joint innervation: implications for diagnostic blocks and radiofrequency ablation. Reg Anesth Pain Med. 2004;39(6):456–64.CrossRefGoogle Scholar
  41. 41.
    Sapir DA, Gorup JM. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study. Spine. 2001;26:E268–73.PubMedCrossRefGoogle Scholar
  42. 42.
    Shen, et al. Radiofrequency thermocoagulation in relieving refractory pain of knee osteoarthritis. Am J Ther. 2017;24(6):e693–700.PubMedCrossRefGoogle Scholar
  43. 43.
    Speldewinde GC. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Spine. 2011;12(2):209–18.Google Scholar
  44. 44.
    Tekin I, Mirzai H, Ok G, Erbuyun K, Vatansever D. A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain. 2007;23(6):524–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Van Eerd M, et al. Cervical facet pain. Pain Pract. 2010;10(2):113–23.PubMedCrossRefGoogle Scholar
  46. 46.
    Van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, De Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine. 1999;24(18):1937–42.PubMedCrossRefGoogle Scholar
  47. 47.
    Van Tilburg CWJ, et al. Randomized sham-controlled double-blind multicenter clinical trial to ascertain the effect of percutaneous radiofrequency treatment for sacroiliac joint pain: three-month results. Clin J Pain. 2016a;32(11):921–6.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Van Tilburg CWJ, et al. Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain. Bone Joint J. 2016b;98-B:1526–33.PubMedCrossRefGoogle Scholar
  49. 49.
    Van Wijk R, Geurts JWM, Wynne HJ, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain. 2005;21:335–44.PubMedCrossRefGoogle Scholar
  50. 50.
    Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003;28(20):2419–25.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Chase A. Kissling
    • 1
  • David Provenzano
    • 2
  • Steven P. Cohen
    • 3
    • 4
    • 5
    • 6
  • Eric T. Lee
    • 7
  1. 1.Walter Reed National Military Medical CenterBethesdaUSA
  2. 2.Pain Diagnostics and Interventional CareSewickleyUSA
  3. 3.Department of Anesthesiology and Critical Care MedicineJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreUSA
  5. 5.Department of AnesthesiologyUniformed Services University of the Health SciencesBethesdaUSA
  6. 6.Department of Physical Medicine and RehabilitationUniformed Services University of the Health SciencesBethesdaUSA
  7. 7.Musculoskeletal Care and Regenerative Medicine,St Charles Spine InstituteThousand OaksUSA

Personalised recommendations