Skip to main content
Lumbar radiofrequency facet joint denervation

Lumbar radiofrequency facet joint denervation

Best Practice Guidance

Summary

Radiofrequency denervation, also known as ‘dorsal rhizotomy’ or ‘radiofrequency ablation,’ is a non-surgical and minimally invasive procedure that uses heat to reduce or stop the transmission of pain signals arising from one or more spinal facet joints. It is only recommended when other alternatives have failed.

 

This guidance applies to adults aged 19 years and over.

How up to date is this information?

Published January 2020 | Last reviewed September 2024


Using this guidance

The guidance set out here was reviewed extensively in the Autumn of 2024. There are no plans for any further reviews.

Medicine is constantly evolving and over time it is inevitable that the evidence base will change. Please use your own judgement and/or other sources of clinical guidance alongside the information set out here.

Please note this guidance is a recommendation and it should be used in the context of the overall care pathway and when all alternative interventions that may be available locally have been undertaken.

Recommendation

Lumbar radiofrequency facet joint denervation (RFD) should only be offered in accordance with NICE Guideline NG59 which recommends it as an adjunct in the management of chronic low back pain only when non-operative treatment has failed, and the main source of pain is thought to arise from one or more degenerate facet joints.

Rationale for recommendation

The facet joints are pairs of joints that stabilise and guide motion in the lumbar spine. These joints are innervated by the medial branches of the dorsal rami. In current clinical practice, suitable patients are first offered one or more diagnostic injections to determine which facet joints are contributing to their symptoms. This particular type of injection is called a ‘medial branch block,’ and differs to facet joint injections, which are no longer recommended by NICE or GIRFT.

Manual therapy, with appropriate psychological therapies where necessary, should be considered as an early intervention to support the individual. Medial branch blocks should be offered only in accordance with the low back pain pathway. Patients who experience a positive response to a medial branch block (i.e. a significant but short term improvement in pain symptoms) may be offered a neurodestructive procedure called radiofrequency denervation in an attempt to achieve longer-term pain relief. Some patients may experience a prolonged response to medial branch blockade such that further interventional treatment is no longer required.

Radiofrequency energy is delivered along an insulated needle in contact with the target nerves. This focussed electrical energy heats and denatures the nerve. This process may allow axons to regenerate with time requiring the repetition of the radiofrequency procedure. Research is ongoing to determine the optimum frequency of repeat radiofrequency denervation.

Patient information

Information for Patients

Radiofrequency facet joint denervation is a procedure where nerves in the back are made inactive by radiofrequency waves (a type of electromagnetic radiation) to relieve back pain. This procedure is also sometimes called ‘dorsal rhizotomy’ or ‘radiofrequency ablation’. The facet joints are small pairs of joints that link the bones of your spine together. If your back pain is thought to be caused by wear and tear at these joints, making the nerves that supply these joints inactive may be helpful in reducing your pain. However, this will only help a small number of people who have been assessed by back pain specialists.

About the condition

Lower back pain is a very common complaint and can affect a person’s quality of life. However, it is rarely caused by serious disease and will often improve over time or with some changes to lifestyle. If other steps to control your pain haven’t worked then your specialist might consider radiofrequency denervation. This involves inserting a needle into your back under local anaesthetic and using heat from the needle to destroy the nerve endings in the joint.

What are the BENEFITS of the procedure?

Most people with back pain do not need this procedure. However, a small number of people who have not found benefit from other treatments may experience reduced pain after this procedure.

What are the RISKS?

There is the risk that the procedure will not work in relieving pain or that the pain may come back after a while. There are also risks of bleeding, infection, and damage to nerve structures around the spine.

What are the ALTERNATIVES?

Continuing with day-to-day activities as much as possible can benefit many people. For some people, losing weight, physical exercise, physiotherapy and/or pain killers may also help. You can discuss alternatives, and what is best for you, with your doctor.

What if you do NOTHING?

Most back pain often settles by itself. However, for many people, periods of back pain may come and go throughout their life.

Coding

WHEN ( Primary_Spell_Procedure like '%V48[57]%' 
AND ( Any_Spell_Procedure LIKE '%Z67[567]%' 
OR Any_Spell_Procedure LIKE '%Z993%')
)
AND LEFT(Primary_Spell_Diagnosis,4) IN ('M512','M518','M519','M545','M549') 
-- Age between 19 and 120
AND ISNULL(APCS.Age_At_Start_of_Spell_SUS,APCS.Der_Age_at_CDS_Activity_Date) between 19 AND 120 
-- Only Elective Activity
AND APCS.Admission_Method not like ('2%') 
THEN '2K_RFD_back'
Exclusions
WHERE 1=1
-- Cancer Diagnosis Exclusion
AND (Any_Spell_Diagnosis not like '%C[0-9][0-9]%' 
AND Any_Spell_Diagnosis not like '%D0%' 
AND Any_Spell_Diagnosis not like '%D3[789]%' 
AND Any_Spell_Diagnosis not like '%D4[012345678]%' 
OR Any_Spell_Diagnosis IS NULL)
-- Private Appointment Exclusion
AND apcs.Administrative_Category<>'02'

References

  1. Nice Guideline (2016) Low back pain and sciatica in over 16s: assessment and management [NG59]
  2. NHS England, Trauma programme of care (2017) National Low Back and Radicular Pain Pathway.
  3. Lamb S, et al on behalf of the Back Skills Training Trial investigators: Back Skills Training (BeST): Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost effectiveness analysis. The Lancet 2010;375;9718,p916-923. DOI https://doi.org/10.1016/S0140-6736(09)62164-4
  4. Nice Guideline (2016) Low back pain and sciatica in over 16s: assessment and management [NG59] endorse STarT Back resource
  5. Maas ET, Ostelo RWJG, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW. Radiofrequency denervation for chronic low back pain. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD008572. DOI: 10.1002/14651858.CD008572.pub2.
  6. Faculty of Pain Management (2015)Core Standards for Pain Management Services in the UK.