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A prior ChiroUp blog discussed the benefits and limitations of Lumbar Medial Branch Radiofrequency Ablation (RFA), also termed Radiofrequency Neurotomy (RFN). The regularity of this procedure has escalated in recent years. While RFN can temporarily eliminate facet pain, patients need to understand that this procedure is similar to placing black tape over a their car’s check engine light- just because they may not feel the pain does not mean the problem is fixed. In fact, new research suggests this procedure may actually accelerate the degenerative process.

Smuck et al. (1) examined the long-term risks associated with RFN. This retrospective study concludes that the full impact of RFN on multifidus function, morphology, and segmental anatomy is unknown; however, measurable changes in segmental morphology may occur after lumbar medial branch RFN. More specifically, levels affected by RFN demonstrated a significantly greater amount of disc degeneration compared with unaffected levels (14.9% vs. 4.6%; p=.0489).

Several peer-reviewed studies have documented the upside of RFN but this is one of the first to examine its long-term repercussions. It is important to educate our patients about their options in the treatment of musculoskeletal pain syndromes. Many patients who undergo RFN would be better served with joint manipulation, ADL advice and a dedicated rehab program. While some cases may not respond as quickly, the long-term outlook is better. RFN should be reserved for those cases that have failed a reasonable trial of conservative care. See the ChiroUP Facet Syndrome condition reference for the current “best practices” on treatment, rehabilitation exercises, ADL modifications, and imaging recommendations.

1. Smuck M, Crisostomo RA, Demirjian R, Fitch DS, et al. Morphologic changes in the lumbar spine after lumbar medial branch radiofrequency neurotomy: a quantitative radiological study. Spine J. 2015 Jun 1;15(6):1415-21.

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