Radiofrequency Medial Branch Neurotomy for Facet Joint Syndrome – How Many is Too Many?

Radiofrequency neurotomy (RFN) of medial branches is an effective and common treatment for the management of lumbar and cervical facet syndrome which can be caused by whiplash. The terms radiofrequency neurotomy, rhizotomy, and ablation are used interchangeably which can cause confusion. But the fact is, abnormalities of the facet joints are a common cause of both neck and low back pain after work-related and MVA injuries with a prevalence of 15 to 40%. 

When conservative methods fail to provide adequate relief, interventional pain management doctors may recommend diagnostic medial branch blocks followed by RFN. Two comparative diagnostic medial branch nerves are performed with local anesthetic to see if RFN is a reasonable option for providing longer-term relief. RFN involves the generation of heat generated by radiofrequency waves to the nerves (medial branches) that provide sensation to the facet joints and the surrounding soft tissues of the spine. RFN cauterizes these sensory nerves rendering them less effective at transmitting a pain signal. Mean duration of successful pain relief (>50% improvement) after RFN is 10.9 months.

Treating pain management doctors rely on clinical studies that show that repeat RFN has been successful in 85% of patients who had a successful initial RFN. But how many repeat RFNs is reasonable and necessary? The little evidence that is available shows that the number of patients who undergo repeat RFN gets significantly smaller as the number of repeated RFN procedures increases. While it is true that some patients return for repeat RFN following an initial RFN, fewer patients return for a third RFN, and very few return for more than three. This is an important observation that defense attorneys should pay attention to as it can have a big effect on the size of settlement for their clients.

In summary, RFN is effective for treating pain from whiplash, but always be prepared to question the reasonableness of the claims of future damages for indefinite or lifetime repeat of the procedure. More information regarding this common procedure is available. Contact me.