Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Chronic back and neck pain can impede daily activities and negatively impact your quality of life. For many people, this pain is not caused by a slipped disc or a pinched nerve in the spinal canal, but by the small, vital hinges that connect the vertebrae together. These are called facet joints. When these joints become arthritic or damaged, they send a constant stream of pain signals to the brain. Facet denervation, also known as radiofrequency ablation or rhizotomy, is a procedure designed to interrupt this signal. It is a way of turning down the volume on your pain without major surgery.
This section serves as your comprehensive guide to understanding what facet denervation is and why it is performed. We will explore the anatomy of the spine in simple terms, focusing on the specific joints and nerves involved. We will clarify the difference between temporary injections and this longer-lasting solution. By understanding the mechanics of the procedure and the biological reasons behind it, you can feel more confident and less anxious about choosing this path for pain relief. The goal here is to demystify the medical terminology and explain the logic of “turning off” a nerve to restore your ability to move and enjoy life.
To understand the treatment, you first need to understand your back’s machinery. The spine is a stack of bones called vertebrae. While the large discs between the bones act as shock absorbers, the facet joints are the stabilizers. They are located on the back of the spine, with one pair on the left and one on the right at every level. You can think of them like the knuckles of your spine. They allow you to bend backward and twist while preventing you from moving too far and damaging the spinal cord.
Like any hinge in the body, such as the knee or elbow, facet joints are lined with smooth cartilage and surrounded by a capsule of fluid. This allows them to glide friction-free. However, these joints bear a significant amount of weight. Over years of movement, or following an injury, the cartilage can wear down. When this happens, the joint becomes inflamed and stiff. The bone may rub against bone, creating friction that the body interprets as deep, aching pain. This condition is mechanically similar to arthritis in the fingers, but because it is deep in the back, it causes muscle spasms and limited mobility.
Every joint in your body has a wiring system that tells your brain what is happening. For the facet joints, these wires are tiny nerves called the medial branch nerves. These are not the large nerves that travel down your legs or arms. They are small, specialized nerves that have a very specific job: they report sensation from the facet joint to the brain. They also control the small muscles directly attached to the spine.
When a facet joint is healthy, these nerves are quiet. When a joint is damaged or inflamed, these nerves become overactive, constantly firing “danger” signals to the brain. This results in the chronic pain you feel. The logic of facet denervation is based on this specific anatomy. Since the medial branch nerves do not control the feeling in your skin or the strength in your major muscles, they can be targeted safely. Interrupting their ability to transmit signals stops the pain report without causing numbness in your limbs or weakness in your legs.
Nerves function like electrical cables. When the facet joint is irritated, it triggers an electrical impulse in the medial branch nerve. This impulse travels up the nerve highway to the spinal cord and then to the brain.
The brain receives this signal and interprets it as pain. It is important to realize that the pain is “real,” but it is essentially a notification. In chronic conditions, this notification system can become stuck in the “on” position. The goal of denervation is to cut the wire delivering this specific notification, allowing the brain to stop perceiving the pain from that specific joint.
Doctors target the medial branch nerves because they are redundant. This means that interrupting them does not cause you to lose any vital function. They are not responsible for moving your legs or sensing touch on your skin.
Because they are located in a predictable groove on the bone, doctors can detect them easily using X-ray guidance. This makes them an ideal target for a procedure. By focusing only on these tiny messengers, the procedure leaves the main spinal nerves and the spinal cord completely untouched and safe.
Facet denervation is a minimally invasive medical procedure used to treat arthritis of the spine. The technical name often used by doctors is radiofrequency ablation (RFA). “Radiofrequency” refers to the type of energy used—radio waves that create heat. “Ablation” means to remove or destroy. So, in plain English, the procedure involves using a specialized needle to heat a small section of the medial branch nerve, effectively destroying its ability to send pain signals.
It is important to clarify that this technique is not a permanent removal of the nerve in the way surgery removes a tumor. It is more like a long-term stun. The heat creates a lesion, or a controlled burn, on the nerve. This process disrupts the nerve fibers, stopping the flow of information. The nerve will eventually try to heal and grow back, which is why the relief is not permanent forever, but it typically provides relief for many months or even years. The procedure is done through a needle, so there are no incisions, no stitches, and usually no scars.
Patients are often confused because they may have had “injections” in their back before. It is vital to distinguish between a steroid injection and denervation. A steroid injection, or a cortisone shot, is a chemical treatment. The doctor injects a powerful anti-inflammatory medicine into the joint to calm the inflammation. The result is temporary, lasting a few weeks or months, and serves to cool down the joint.
Denervation is a thermal (heat) treatment. It is a physical alteration of the nerve structure. It is usually the second step in the treatment ladder. Doctors typically start with injections. If the injections work well but the pain comes back quickly, it proves that the facet joint is indeed the culprit. Once this scenario is proven, denervation is offered as a longer-lasting solution.
Not everyone with back pain is a candidate for this procedure. It is specifically designed for people whose pain is coming from the facet joints, not from a disc or a pinched nerve in the canal. Candidates are usually people who have had back or neck pain for more than three to six months and have not found relief with physical therapy, chiropractic care, or medication.
The most critical requirement for being a candidate is a successful “test drive.” Before doing the actual denervation, doctors will perform a diagnostic nerve block. They numb the nerve temporarily with anesthetic. If this temporary numbing takes away your pain for a few hours, it confirms that the facet joints are the source. Only patients who get significant relief from this test block are eligible for the full denervation procedure.
Doctors act conservatively, meaning they try the easiest and safest treatments first. You are a candidate if you have tried resting, taking anti-inflammatory pills, and doing strengthening exercises without success.
If you are unable to do the things you love—like gardening, golfing, or simply sleeping through the night—because of mechanical back pain, and simple treatments haven’t worked, you fit the profile. The procedure is for those who need a bridge to get back to an active life.
The diagnostic block is the “green light” for the procedure. It involves injecting a small amount of numbing medicine near the nerve. You then go home and keep a pain diary.
If you report that your pain dropped significantly—usually by 50% to 80%—during the hours the numbing medicine was active, it is a positive result. This proves to the doctor that burning that specific nerve will give you the relief you are looking for. Without this positive test, the procedure is rarely performed.
The primary goal of facet denervation is to reduce pain, but the ultimate goal is to restore function. When you are in less pain, you can move more. When you move more, your muscles become stronger, which supports your spine better. It is a positive cycle. Most patients experience a significant reduction in pain, often described as going from a “screaming” pain to a distant “whisper.”
Success rates are generally high for patients who have been properly diagnosed. Studies show that 70% to 80% of patients experience significant pain relief that lasts anywhere from six months to two years. While it does not fix the arthritis in the bone—the joint is still worn out—it makes the condition bearable. It allows many patients to avoid or delay major spinal fusion surgery. It is a quality-of-life procedure, giving you back the ability to participate in your daily activities.
Send us all your questions or requests, and our expert team will assist you.
No, the relief is not permanent because the nerve eventually regrows. The body is constantly trying to heal itself. However, the relief typically lasts between 9 months and 2 years. If the pain returns, the procedure can be repeated successfully.
Often, yes. You are given “twilight” sedation, similar to what is used for a colonoscopy. You
No. The medial branch nerves targeted in this procedure are sensory nerves for the joint. They do not control the large muscles that move your legs or arms. You will not lose strength or balance as a result of the nerve being treated.
are very relaxed and feel no pain due to local anesthesia, but you are breathing on your own. This allows you to communicate with the surgeon if needed, providing feedback on your pain levels.
You are usually given local anesthesia to numb the skin and often mild sedation to help you relax. You might feel some pressure or a deep ache when the doctor is working, but it is generally well-tolerated. The actual heat lesion takes less than 90 seconds.
No. Because you may receive sedation and your back might be sore, you cannot drive immediately after the procedure. You must arrange for a friend or family member to drive you home.
You might notice a small patch of numbness on the skin of your back near the injection site, but this is usually minor. The procedure targets the deep nerve inside the joint, not the skin nerves, so widespread numbness is rare.
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