by Nicole Berardoni M.D., Paul Lynch M.D., and Tory McJunkin M.D.

Bulging DiscDisc denervation is a pain procedure used to treat chronic disc related or discogenic pain. Affected pain-causing nerves are heated and destroyed with radiofrequency. The heat generated from the radiofrequency modifies certain nerve fibers and blocks the perception of pain that is received by the brain. Radiofrequency denervation is a superior technique to other treatments based on the thermocoagulation of selected nerves using an electrode capable of accurate temperature generation (Ahmet 2006). Neuropeptides (chemicals) released from the periphery of your nerves are nociceptive (pain sensing) inflammatory mediators as well as pain generators. The nerves connect to the spinal cord which eventually sends the signal to the brain to sense pain. When the nerves are identified that are causing pain, successful pain relief has been obtained when they are denervated (Koscharskyy 2007).

Anatomy

Disc DenervationThe anatomy and physiological function of the spine is important in evaluating a person with pain. The bony spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. The facet joint of the spine is a moveable connection that connects one vertebra to another. They are highly innervated with nerves that provide sensation and often pain. Separating each individual vertebrae are discs that act as cushions to minimize the impact that the spinal column receives. The discs are designed to be soft and provide support, but have a tendency to herniate backwards, causing irritation to the adjacent nerves. Disc disease is one of the most common causes of chronic neck or back pain and accounts for approximately 10% of all lower back pain complaints. Disc disease may be acute, herniation resulting from trauma, or, more commonly, chronic caused by degenerative disc disease. Degenerative disc disease is a process which is due to a thinning and degeneration of the discs over time and can lead to a disrupted spinal function, nerve impingement, or peripheral nerve irritation. Disc denervation is considered for patients who have disabling chronic pain, especially when due to a discogenic pathology and when conservative treatments have failed. Neck and back pain are the most common complaints that are treated with disc denervation.

Procedure

Prolapsed DiscIn disc denervation, your pain physician uses a device to generate heat in order to dull the nerve that is causing the pain. Using a small thin needle, your physician will administer a local anesthetic to numb your skin and subcutaneous tissue. A radiofrequency needle is advanced under fluoroscopy or real-time X-ray to the desired location. Electrical stimulation is initiated through the needle, and your disc pain is duplicated. When the correct nerves have been identified, the nerve supply to the disc is denervated with radiofrequency. This technique can destroy pain-causing nerves and minimize the effects on the surrounding structures. A band-aid is placed over the needle entry location after the procedure. The procedure typically takes less than an hour, and you are able to go home shortly after.

Benefits

Disc denervation has several advantages for the treatment of back and neck pain. It is a minimally-invasive procedure which may provide significant relief. No hospitalization is required, and the procedure is performed with local anesthesia and sedation. Typically, there is little post-procedure discomfort, and you are able to quickly resume your normal activities. Another advantage to disc denervation is that denervation can be controlled, minimizing the risk of damaging adjacent nerves. Also, if the pain recurs, this minimally-invasive treatment may be repeated.

Risks

Complications associated with disc denervation are rare. This treatment option is associated with an overall 1.0% incidence rate of minor complications per patient (Kornick 2004). As with all surgeries and procedures there is a risk of bleeding, infection, or nerve damage. The most common complaint is pain at the procedure site after the local anesthetic has worn off.

Outcomes

RadioFrequency Ablation Prolapsed DiscRadiofrequency denervation procedures have been used as pain management for over two decades. In a large clinical study performed in 2007, 68% of the patients treated with radiofrequency denervation had good to excellent pain relief lasting from six to 24 months. This large, prospective clinical study indicated that radiofrequency denervation of the lumbar zygapophysial joints provides long-term back pain relief in a routine clinical setting (Gofeld 2007). Radiofrequency denervation results in significant alleviation of pain and allows for an increase in daily functioning and movement. These results were seen in many patients with chronic low back pain, both on a short-term and a long-term basis (can Kleef 1999). With various research studies underway, denervation procedures may be considered as a viable treatment option in patients who are suffering from back pain (Oh 2007). If you are suffering from chronic back or neck pain that has been refractory to other treatments contact Arizona Pain Specialists today to see if you can benefit from this innovative treatment. We are happy to provide the cutting-edge of pain medicine to the Phoenix area.

At Arizona Pain, our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

Journal Articles

  1. Principles and Uses of Radiofrequency Nerve Lesioning in Chronic Pain Control Ahmet H. Ozturk, MD CHH Pain Management Clinic Complications of lumbar facet radiofrequency denervation. Kornick C; Kramarich SS; Lamer TJ; Todd Sitzman B Department of Anesthesiology, Division of Pain Management, Mayo Clinic, Jacksonville, Florida, USA. Spine. 2004; 29(12):1352-4 (ISSN: 1528-1159)
  2. Lumbar discogenic pain. Disk degeneration and minimally invasive interventional therapies Kosharskyy B, Rozen D. Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Apr;42(4):262-7
  3. Radiofrequency denervation of the lumbar zygapophysial joints: 10-year prospective clinical audit. Gofeld M, Jitendra J, Faclier G. Pain Physician. 2007 Mar;10(2):291-300
  4. A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain. Oh WS, Shim JC. Clin J Pain. 2004 Jan-Feb;20(1):55-60
  5. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Spine. 1999 Sep 15;24(18):1937-42