RFD (radiofrequency denervation) of the spine. What is it, cost of surgery, reviews

About 20% of the working population suffers from back pain for about 4 weeks annually. This deviation is one of the first in frequency among middle-aged people. The cause of pain in most cases is protrusion and herniation of intervertebral discs, which form with osteochondrosis.

Radiofrequency denervation (RFD) of the spine has been used in medical practice since 1973 in the treatment of radiculopathy accompanied by acute and prolonged pain. It occupies an intermediate position between traditional surgical methods and conservative methods: drug therapy and physiotherapy.

The essence of the method

RFD of the spine is a minimally invasive method of surgical treatment of degenerative-dystrophic pathologies of the spine. Its principle is to warm up the nerve endings and destroy them.

RFD of the spine

As a result, the pain syndrome is eliminated. The nerve endings that carry pain from the spine to the brain are “switched off” by pinpoint cauterization of an electric current, which is how denervation occurs.

The procedure is most often performed in the lumbar region. In more rare cases - in the cervical and thoracic.

There are also the following varieties of this technique:

• By the method of exciting electric current pulses: with constant pulse transmission from a radio frequency generator;
• with variable pulse generation.

The denervation itself can be carried out not only using electric current, but also chemically (alcohol is introduced), as well as using a plasma field or laser.

Denervation of the facet joints

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• Types of clinic activities
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• Radiofrequency denervation
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• Denervation of the facet joints

“Radiofrequency denervation - treatment of back pain by coagulating the nerve endings of the facet joints with an electromagnetic field”

Where should you look for salvation if your back hurts in order to avoid surgery and not waste money?

The source of back pain is often pathology of the intervertebral discs, joints, ligaments and muscles. Degenerative changes in the lumbar region cause unbearable pain. The most common cause is osteoarthritis, in particular, one of its forms is spondyloarthrosis. As it progresses, this pathology slowly destroys the vertebral joints. The condition is aggravated by physical inactivity, many infectious diseases and excess weight.

“Radiofrequency denervation is a modern, high-tech, minimally invasive technique designed for patients with pain in the spine who are not sufficiently helped by conservative treatment of the spine. The essence of radiofrequency denervation (other names: ablation, rhizotomy, neurotomy) is the effect of ultra-high frequency electric current on the roots of nerve endings. Thanks to this, the pain syndrome practically disappears for a long time, returning the patient the ability to move.”

Description of the method

This is a low-traumatic procedure recommended if therapeutic treatment is insufficiently effective. By puncture method (through punctures) under the control of an image intensifier (electron-optical converter, intraoperative X-ray), special needles with small electrodes at the ends are inserted exactly to the side of the intervertebral joints. Through these needles, a low-frequency current is alternately applied and the nerve endings located in the capsule of the facet joints are stimulated. As a result, the nerve endings are coagulated (cauterized) and the pain syndrome goes away.

“It should be noted that coagulation of nerve endings does not harm the body, but only relieves the patient of pain in the facet joints. The duration of treatment effect in most patients ranges from one to several years.”

Radiofrequency denervation of the spine is performed with local anesthesia and monitored by interoperative X-ray. Facet rhizotomy involves the passage of high-frequency currents through the body tissues to the nerve endings and their destruction. A prerequisite for success is to ensure complete immobility of the patient in order to insert the electrodes as accurately as possible.

• A puncture is made in the nerve tissue and needles are inserted, at the ends of which small electrodes are installed through which a current passes.
• Overcoming tissue resistance, the temperature of the plates rises.
• The result of exposure is cauterization of the nerve.
• During exposure, slight painful sensations may occur.

The whole procedure takes no more than 40 minutes.

Advantages of using RFD of the spine:

• high efficiency with minimal time costs;
• fast recovery;
• improving quality of life;
• local anesthesia is sufficient;
• the impact is only on a small area that is well controlled;
• the procedure is non-traumatic, well tolerated, and there is virtually no risk of side effects;
• It is possible to repeat RFD.

Indications for surgery

Spondyloarthrosis. The most common cause of chest and neck pain is the facet joints. In treatment, injections are ineffective, they act for a short time or give partial results. RFD of the spine in this case is the preferred manipulation, blocking pain for a longer time.

Discogenic pain. Its spread most often occurs in pathology of the lower spine, when the patient feels severe pain in the affected area, transmitted to the arms and legs. The situation is complicated by limited mobility. The use of RFD in such cases shows effectiveness if surgical intervention is not required.

If the cause of pain is spinal stenosis, the use of RFD is the most effective and preferred measure.

Pain in the coccyx area can also be relieved by RFD of the coccygeal nerve.

Severe constant or paroxysmal headache.

Rules for preparing for RFD

Obtaining positive dynamics largely depends on a complete preoperative examination, which includes:

• X-rays of light.
• neurologist's report;
• MRI;
• general blood and urine test, blood test for RW, hepatitis, HIV;
• ECG.

Radiofrequency denervation of joints requires the following precautions:

• some restrictions on food intake - you can’t eat for eight hours before the procedure and drink for two;
• when using insulin, the dose administered on the day of the procedure should be adjusted;
• the decision to stop taking medications is made by a specialist;
• there is a need to refrain from driving vehicles for 12 hours after the procedure.

Contraindications

The manipulation is not performed if the patient:

• spinal cord damage;
• severe anemia;
• fever;
• severe infectious disease;
• deterioration of health.

If these symptoms are present, the patient is indicated for conservative treatment.

The doctor analyzes the patient’s condition, existing indications and contraindications to determine the advisability of prescribing radiofrequency denervation.

Efficiency of the procedure

The therapeutic effect of the procedure is noticeable immediately, the pain syndrome disappears. The final result can be assessed after one and a half months, since in some cases effectiveness appears only after this period.

The effectiveness of such treatment in various cases can last up to several years. In many cases, the patient needs to engage in physical therapy to restore and develop the joint. If pain relief is not provided, a person will not be able to exercise - the pain will not allow him to move normally. After the procedure, patients begin to exercise, which helps avoid surgery altogether or postpone it for a long time.

If the necessary measures are not taken in a timely manner, pain will become a constant daily test for a person, and there can be no talk of an active lifestyle at all, because even the simplest movements will be difficult.

Possible complications

To date, none have been identified. Some discomfort may be observed, and a hematoma or hyperemia may form at the puncture site. Within a short time, these manifestations usually disappear.

The absence of side effects is due to medical supervision.

Indications for surgery

The main indication for the use of this technique is spondyloarthrosis - dystrophic damage to the joints located between the vertebrae.

In most cases, this pathology occurs against the background of osteochondrosis - changes in the intervertebral discs as a result of metabolic disorders. Less commonly, spondyloarthrosis is caused by injuries or chronic overloads of the spine.

The operation is performed for those patients who experience the following symptoms:

• long-term (more than six months) pain in the back, chest or neck, which intensifies after straightening or standing for a long time, sitting, as well as upon palpation;
• lack of effect from conservative (drug) treatment and physiotherapy for at least 1.5 months;
• limitation of motor activity, forced incorrect position of the head, asymmetry of the shoulder girdle with damage to the cervical spine;
• reduction of pain after diagnostic blockade, which is described below;
• the presence of contraindications for open surgery for the above symptoms (for example, inoperable forms of cancer).

Pain with spondyloarthrosis occurs due to deformation of the intervertebral joints as a result of changes in the discs, decreased height of the spaces between adjacent vertebrae, and damage to ligaments and muscles. Before surgery, these changes must be confirmed by X-ray and MRI examination of the spine.

What is SIJ syndrome?

The sacroiliac joint is a stiff joint (amphiarthrosis) between the lateral surface of the sacrum and the pelvic bone. The amplitude of movement in this joint is very small and amounts to 2-3 mm, hence the debate among anatomists as to whether it is a joint or a syndesmosis. Mobility in this joint is especially important and increases in the prenatal period in women for the divergence of the pelvic bones during childbirth.

Degeneration of the SIJ, a decrease in its stability, and an increase in the amplitude of pathological mobility causes a pain syndrome called SIJ syndrome. It occurs in various age and social groups. The disease affects older patients with disorders of the spinal axis, osteoporosis, young athletes with chronic overload in these joints, men and women. SIJ syndrome manifests itself as pain in the lower back, displaced slightly to the side from the midline, pain in the buttock, groin area, and can radiate to the back and even the inner surface of the thigh. Pain in SIJ syndrome does not radiate upward from the main focus.

Contraindications

RFD of the spine is a technique that has a number of contraindications.

These include:

• damage to the fibrous rings of the spine - rupture or protrusion (its bulging into the spinal canal);
• dependence on narcotic and painkillers;
• protrusion of the intervertebral disc exceeding 1/3 of the size of the spinal canal in the longitudinal plane;
• spinal cord injury, spinal fracture;
• reduction in the height of the intervertebral disc by more than half;
• spinal circulation disorder;
• significant damage to the spinal cord roots along the length of 2 adjacent vertebrae;
• mental and other illnesses that do not allow establishing contact with the patient;
• tumors in the spinal column;
• the patient's age is under 18 and over 72 years;
• local or general infectious process; this is a relative contraindication; after eliminating the disease, surgery becomes possible;
• history of spinal surgery;
• narrowing of the spinal canal, congenital or acquired;
• progression of neurological symptoms: pain and weakness in the limbs.

Advantages of the technique

The advantages of this treatment method include:

• minimal invasiveness (penetration into the patient’s body) and greater safety compared to traditional open operations;
• control over the process of destruction of nerve fibers, constant monitoring of heating temperature and tissue resistance;
• only local anesthesia, possibility of treatment on an outpatient basis;
• few complications;
• the possibility of combining with conservative methods of treatment, which increases the overall effectiveness of therapy;
• simultaneous diagnostics;
• rapid recovery of patients after surgery;
• possibility of repeating the procedure.

Open surgical interventions for spondyloarthrosis lead to disability in 8-25% of patients. Often in the postoperative period complications such as scar formation in the spinal cord, radiculitis, inflammation of the interdiscal space, and damage to blood vessels occur. RFD does not have these disadvantages.

Rules for preparing for RFD, examination before intervention

The list of necessary examinations and the duration of their conduct before the operation are shown in the table below:

Before the operation, it is necessary to undergo an examination by an orthopedist to determine the indications for surgical intervention and by an anesthesiologist (performed directly in a hospital setting). It is recommended to conduct a test blockade in advance to establish the source of pain (injection of a solution of lidocaine or novocaine at the level of the lesion). It should be prescribed by an orthopedic surgeon.

The patient is admitted to the hospital either on the day of surgery or the day before. It is recommended to avoid eating and drinking on the day of surgery.

For emotionally excitable patients, the doctor may offer sedatives, since the procedure takes place with the patient fully conscious and full contact must be ensured between him and the surgeon. Your doctor may also recommend wearing compression stockings to prevent swelling in your legs (during lumbar surgery).

Preparation and implementation

Before RFD, a comprehensive examination of the spine and a blood test are performed.
Before the intervention, the patient needs to undergo tests to identify possible contraindications and increase the effectiveness of the procedure: do an MRI, ECG and X-ray, examine blood, urine, and obtain a neurologist’s opinion. They also check for hepatitis, HIV and RW.

If the tests are in order, start preparing:

• receive medical advice when taking any medications, if possible, postpone them until after rehabilitation;
• when using insulin against the background of diabetes, adjust the dosage on the day of surgery;
• 8 hours before denervation do not eat food, stop drinking 2 hours before the procedure.

Since patients are often immediately discharged home after the intervention and are not allowed to drive, relatives should be invited to accompany them.

Method of denervation

Needles are inserted into the diseased area, then electrodes are connected to them.
Destruction is carried out under the control of an electron-optical converter operating using the X-ray method. Local anesthesia is administered before instrument integration. Next, treatment begins:

1. Special needles with electrodes are inserted through a puncture into the nerve roots. This is done very carefully, between the discs, on the side of the spine.
2. Electrodes are connected and ultra-high frequency current is applied in the range from 2 to 100 Hz.
3. With this effect, the ends of the needle form a natural temperature, which cauterizes the nerve and quickly destroys it. As a result, the transmission of nerve impulses becomes impossible.
4. The procedure time is from 20 to 40 minutes, followed by transfer of the patient to the observation room.

During the procedure, it is important that the patient is immobilized, otherwise the needle will not work accurately.

In most cases, people stay in the room after denervation for about 2 hours. Then they are sent home.

Progress of spine surgery

RFD of the spine is a minimally invasive surgical intervention.

This operation is performed in the following sequence:

1. The patient is taken to the operating room, where he is placed lying on his stomach when performing surgery on the lumbar spine, on his back - on the thoracic spine, sitting when the cervical spine is affected.
2. Antiseptic treatment of the surgical field is performed.
3. Needles are installed at certain points along the spinal column through punctures in the skin and soft tissues (most often 6 pieces on one side or on both sides, symmetrically). Thin electrodes are passed through them, the length of which ranges from 50 mm for installation in the cervical region and up to 150 mm in the lumbar region. Their length is also selected individually, depending on the thickness of the patient’s subcutaneous fat. Control over the insertion of needles is carried out using a fluoroscope or using ultrasound navigation.
4. The free end of the electrode placed into the human body is not insulated. It generates electric current supplied from a radio frequency generator.
5. Electrical stimulation of the nerve is performed to confirm correct needle placement. In this case, the patient complains of increased pain.
6. After this, motor stimulation is carried out by increasing the voltage. If there is no muscle contraction, then the surgeon can proceed directly to the destruction of the nerve.
7. 1 ml of anesthetic (most often a 0.5% novocaine solution) is injected into the needle.
8. The temperature on the generator is set to +80°C and electric current is supplied.
9. Spot heating of tissues occurs due to the presence of resistance in them. The nerve involved in the pathological process is destroyed. The exposure time is 60-90 s. The procedure itself is painless, and sometimes a feeling of warmth may occur.
10. After the destruction of the nerve is complete, one of the hormonal drugs (Kenalog, Diprospan or Depo-Medrol) is administered to reduce the inflammatory process.
11. Electrodes and needles are removed from the tissue, and puncture sites are treated with antiseptics. Then a sterile bandage is applied to the damaged surface.

The patient remains fully conscious throughout the operation. The doctor constantly talks with the patient to assess his condition. Active movements of the limbs and body are not allowed, as this can lead to injury.

Recovery period

The operation is well tolerated by the patients. In the next half hour, it is necessary to observe bed rest, since the administration of an anesthetic drug can lead to a drop in blood pressure. If weakness is felt in the limbs due to the soaking of the spinal nerve root with an anesthetic, then complete rest is indicated for 1-2 hours.

At this time, the patient may be given a drip to dehydrate the body. Measures are also taken to prevent inflammatory processes (Paracetamol is administered intravenously, Xefocam, Voltaren and other drugs are administered intramuscularly).

After this, patients are allowed to get up. If the operation was performed on the cervical spine, it is fixed with a head holder. The duration of fixation can be 1 week. You are allowed to resume daily activities after 1 day. Full functionality is restored after 5-7 days.

You can drink and eat immediately after surgery. If the patient feels well, he can be discharged on the same day, but most often patients are left in the hospital for 2-3 days.

In the next 4-6 weeks, it is recommended to avoid heavy physical activity and sports, but therapeutic exercises of the limbs are indicated. In the future, it is also necessary to be under the supervision of a neurologist at the place of residence.

Rehabilitation period

During the recovery period, moderate physical activity is recommended.
Full recovery after radiofrequency destruction occurs in 1-1.5 months. In rare cases, a visible effect develops only a few months after the intervention, when the patient has already accepted as a fact that the procedure was ineffective.

During rehabilitation, it is important to follow the rules:

• a complete ban on heavy lifting and physical activity;
• Exercise therapy is performed under the supervision of a specialist no earlier than after 2-3 weeks;
• NSAIDs are prescribed to relieve residual pain.

The recovery period passes without serious restrictions and complications. It is important to control your weight, eat a balanced diet, and avoid starvation. It is advisable to reduce the level of stress and worries.

Possible complications

In older people, the puncture site may take longer to heal.
After denervation, side effects are extremely rare. They can be caused by improper disinfection during surgery, ignoring contraindications and incorrect behavior of the patient during rehabilitation.

Mild pain and discomfort, slight redness and bruising at the puncture site are a normal reaction of the body. If the bruises become swollen, severely painful, swollen, or discharge pus, you should consult a doctor.

Infection of the area where the intervention was performed is extremely rare. Possible consequences such as weakness, temporary limitation of mobility. In exceptional cases, increased pain is observed.

Efficiency of the procedure

Positive results after treatment are observed in 60-80% of patients. At the same time, they can be divided into 2 groups - those in which pain decreases immediately after surgery, and those in which the analgesic effect develops after 1.5-2 months.

The latter phenomenon is associated with a gradual physiological change in the dorsal horns of the spinal cord. The smallest effect was recorded for patients with chronic pain in the thoracic region (44% of patients). On average, noticeable pain relief is observed 5-7 days after surgery.

RFD of the spine is an operation that may not be effective in the following cases:

• pronounced radicular syndrome, in which compression of the spinal roots occurs;
• stenosis (narrowing) of the spinal canal;
• incomplete denervation (repeating the operation can increase the effectiveness by another 30%);
• the patient has other sources of pain other than intervertebral joints;
• incorrect technique for inserting the electrode (at an angle to the target nerve, and not parallel);
• scars or adhesions in the area of ​​intervertebral joints.

It is important before surgery to establish the exact cause of pain in the spine, using MRI, radiography and screening blockade with anesthetics.

It should also be noted that damaged nerves can recover. Therefore, pain may return with varying degrees of intensity after 3-6 months. After 1.5 years, in some patients it reaches the same strength as before surgical manipulation.

The essence of the method and indications

Radiofrequency denervation is an application of electric current to the vertebral joints.
High-frequency denervation of the facet joints is an operation that destroys cells in the nerve endings. Not in large fibers, but in the smallest parts of the roots located next to the vertebral joints. The technique works through thermocoagulation: an electric current passes through the tissue and heats the roots, providing a cauterization effect.

There are several indications for prescribing such an intervention:

• Spinal stenosis and the pain it causes. When narrowing, RFD is considered the preferred method for relieving acute symptoms without requiring surgery.
• Discomfort in the tailbone. It is not always possible to solve the problem conservatively, and the symptom is associated with pathological changes in the structure of the structures.
• Discogenic pain. This type includes a symptom caused by diseases of the lower spine. Accompanied by significant restrictions on mobility, pain radiating to the legs or arms. Sometimes compression of the roots develops.
• Spondyloarthrosis. When injection blocks fail, RFD becomes the best method for denervation of the facet joints.
• Migraine. If a person has persistent headaches of this type due to a spinal nerve condition, they may be prescribed RFD as a method of eliminating the need for medication.
• Intercostal neuralgia. Severe pain by radiofrequency destruction is treated only in the case of a chronic course of this disorder.

The doctor may prescribe intervention for other conditions when the patient suffers from pain for more than 6 months.

Possible complications

The following complications may occur:

• Weakness and numbness of the limbs. This negative phenomenon can occur when the operation is performed under general anesthesia and there is no contact with the patient, as well as when there is a gross violation of technique, lack of control over the introduction of electrodes, as a result of which the ventral branches of the spinal nerve are damaged.
• Infectious and inflammatory complications. They occur when the rules of asepsis and antisepsis are not followed during surgery.
• Feeling of heaviness in the surgical area. It does not require treatment and goes away on its own in 3-6 weeks. Some patients experience mild pain for 1-2 weeks.
• Bleeding , which is also characteristic of rough surgical techniques.
• Recurrence of herniation in the spine, increased pain.
• Anaphylactic reaction associated with individual intolerance to anesthetics (Lidocaine, Novocaine).

According to the results of a study of operations, the complication rate is no more than 1%.

Cost of the operation, where can RFD be performed?

The operation can be performed in traumatology and orthopedics centers. It is provided free of charge in cases where the patient is provided with a quota for high-tech medical treatment. The cost of a paid operation averages 35-50 thousand rubles, and in some clinics reaches 80 thousand rubles.

Radiofrequency denervation is a progressive method for treating spinal diseases, characterized by safety and fairly high efficiency.

With RFD, patients can reduce the intensity of chronic pain or get rid of it completely, which significantly improves quality of life and reduces the need for pain medications. However, it must be borne in mind that this method does not eliminate the cause of the disease, but only helps to cope with its symptoms.

Efficiency and reviews of the procedure

There are a minimal number of opinions about destruction on the Internet. Even patient reviews about radiofrequency denervation of spinal joints indicate that there is little information and research on the method. They all claim that this method of treatment is not effective.

RFD is often available on a quota basis and does not cause discomfort at the time of implementation. Some people write that the pain goes away within a couple of days, but after 1-2 weeks other unpleasant symptoms may appear. Weakness and weakness in the body are the most common consequences of minimally invasive surgery.

The cost of the procedure without a quota is very high - on average 30,000 rubles in Moscow. Prices for RFD of the spine depend on the status of the clinic. In other cities they may be lower.

According to the description of the methodology itself, its effectiveness can be assessed only 1-1.5 months after implementation. Against this background, we can conclude that not all reviews about the lack of results could be written only after this period. The description also says that the effect does not last forever, but for a period of 1 to several years, provided that the person follows the instructions: exercise, proper nutrition, proper rest.

If the patient ignores the recommendations and the operation is performed using low-quality equipment, the result will be minimal. This is true for any procedure to restore mobility of joints and vertebrae.