Cervical Radio Frequency

The diagnosis your doctor has given you that explains why your neck hurts is cervical facet arthritis. This diagnosis was made because your neck pain was relieved after your doctor anesthetized your facet joints. Unfortunately, the pain is recurring and requiring repeated injections for relief because your facet joints are too degenerative (“bone on bone”) for the steroid injections to be of any further benefit.

What can we do now?
An option at this time, other than a surgical fusion, would be to destroy the nerves that are conducting the painful signals from your facet joints. This procedure is referred to as a denervation. (“removing or destroying a nerve”). Much like the dentist removing the pain generating nerve from a tooth during a root canal, this procedure only destroys the nerve that causes the pain and not the nerves that cause you to touch, feel or move your limbs.

Where are these nerves?
The nerves that innervate the facet joints are the nerves that exit from the spinal cord and split into two branches. One goes forward toward your throat referred to as the anterior rami (rami means “branch”) and forms the nerves that allow you to feel and move your arns. The other branch a posterior rami that curves toward the skin of your neck which conduct pain signals from the joints and some muscles of the spine. These posterior rami are the target group of nerves. These nerves lie in the middle of a “trapezoid” formed by the joints above and below and a bone jutting out perpendicular to the joint called the transverse process. Although nerves cannot be seen on xray, this “trapezoid” is very easily seen on fluoroscopy (xray) such that the tip of a needle could be placed directly next to the nerve.

How do you destroy this nerve?
Using a special needle that is insulated except at the last few millimeters of the tip, electricity is sent down the needle at the speed of radio waves (60,000cycles/sec) creating heat. Just like a bowl in your microwave does not get hot but the food in side does, the needle stays cool while the tissues immediately around the needle get very warm. Indeed, this heat can be adjusted to be hot enough to destroy the pain nerves but not hot enough to do any collateral damage to surrounding tissues and nerves. This technique of denervating the facet joints is called radiofrequency technique.