Radiofrequency ablation (RFA), also called facet rhizotomy or radiofrequency neurotomy, is performed at PHI in Beverly Hills by board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi. Guided by fluoroscopy, it heats the small nerves that carry pain from a facet, sacroiliac or knee joint. Relief from spinal RFA typically lasts 6 to 18 months, and the procedure can be repeated.
What Radiofrequency Ablation Does
Radiofrequency ablation quiets the small nerves that carry pain signals from one specific joint. Your physician guides a thin probe to each nerve under live X-ray and heats a pinpoint area of it, so the nerve stops sending those signals. [1]
A steroid injection calms inflammation and usually helps for weeks or a few months. RFA works on the pain signal itself, so the relief lasts much longer. The nerves do grow back over time, and when the pain returns, the procedure can be repeated.
Facet Rhizotomy, Neurotomy and RFA Are One Procedure
If a doctor has recommended a facet rhizotomy, a radiofrequency neurotomy or a medial branch ablation, this is almost always the procedure they mean. For facet joint pain, each name describes heat placed on the medial branch nerves, the small nerves that carry pain from the facet joints of the spine. [1] Radiofrequency neurotomy is simply another name for RFA. [2]
Patients usually search for it by the part of the spine it treats. A lumbar facet rhizotomy treats the low back, and a cervical facet rhizotomy treats the neck. At PHI both are radiofrequency ablation, done by the same two physicians in the same surgical suite, and both are covered on this page.
Two Steps, Starting With a Diagnostic Block
RFA starts by proving where the pain comes from. First comes a diagnostic block, a small dose of numbing medicine placed on the nerves suspected of carrying your pain. If the pain eases for the hours the medicine lasts, those nerves are the right target. [1]
That response is the best predictor that RFA will work. [3] Patients who got good relief from a facet joint injection that wore off too soon are often good candidates for RFA. When the first block gives clear relief, PHI can often go straight to the ablation. For the neck, or when the response is less certain, your physician may recommend a second, confirming block.
Five Areas We Treat
Cervical RFA (cervical facet rhizotomy)
For neck pain from the cervical facet joints, including pain that began with whiplash. In a randomized trial of patients with chronic neck pain after whiplash, relief after the real procedure lasted many months longer than after a sham procedure. [4]
Thoracic RFA
For mid-back pain from the thoracic facet joints. It is less common than neck or low back pain, and it often goes undiagnosed.
Lumbar RFA (lumbar facet rhizotomy)
For low back pain from the lumbar facet joints. It is the most common RFA procedure, and it has been studied extensively. [1]
Sacroiliac RFA
For pain from the sacroiliac joint, where the spine meets the pelvis. SI joint pain is a frequent and frequently missed cause of low back and buttock pain.
Genicular RFA
For chronic knee pain from osteoarthritis. It helps people who are not ready for a knee replacement, are not candidates for one, or still have pain after one.
Why Patients Choose PHI for RFA
X-ray guidance, every time
Every ablation is performed under fluoroscopy in our affiliated QUAD A-accredited surgical suite at 455 N Roxbury Drive, Beverly Hills.
Two board-certified physicians
Dr. Faisal Lalani and Dr. Nadiv Samimi, both trained in interventional pain at Cedars-Sinai.
One physician from block to ablation
The same physician carries you from your diagnostic block through your ablation.
Thermal or pulsed RFA
Thermal or pulsed RFA, matched to your condition.
Neck to knee under one roof
Neck, mid-back, low back, sacroiliac joint and knee, treated by the same physicians in the same suite.
Patients from near and far
Patients come from across Los Angeles and from Las Vegas, Palm Springs and London, and we coordinate the block, the ablation and follow-up across visits when needed.
Is RFA Right for You?
RFA is a strong fit when
- A diagnostic injection (medial branch block, facet joint injection, genicular nerve block or sacroiliac joint injection) confirmed where your pain comes from
- That injection helped, but the relief wore off sooner than you wanted
- Your pain comes from a facet, sacroiliac or knee joint
- Physical therapy, medication and shorter-lasting injections have not given you lasting relief
Start with a different step when
- Your pain has not yet been traced to a specific joint
- Imaging points to a pinched nerve more than a joint
- A diagnostic block did not ease your pain
- Your pain suggests spinal instability or another condition RFA does not treat
Your RFA, Before and After
Confirming the fit
Your physician reviews your imaging, your diagnostic block results and your history. Some blood thinners are paused beforehand, and you will get specific instructions.
The ablation
Most ablations are done under sedation and take about 60 minutes, depending on how many levels are treated. Numbing medicine eases the needle path, and you may feel pressure or warmth at each site.
Recovery
You rest in the recovery area for 30 to 60 minutes. Plan for a ride home, since you cannot drive the same day.
Full benefit
Relief builds over the following weeks. For spinal RFA it typically lasts 6 to 18 months, and the procedure can be repeated when pain returns.
Questions About RFA and Facet Rhizotomy
Yes. Facet rhizotomy, radiofrequency neurotomy, medial branch ablation and RFA all name the same treatment for facet joint pain. A lumbar facet rhizotomy treats the low back and a cervical facet rhizotomy treats the neck.
For the spine, typically 6 to 18 months, and longer for some patients. Relief after knee RFA is often shorter. When the nerves grow back and pain returns, the procedure can be repeated.
Board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi perform every RFA in our affiliated surgical suite in Beverly Hills. Patients come to us from across Los Angeles.
A good response to a diagnostic injection aimed at the same nerves is the strongest sign. PHI usually asks for a confirmed diagnostic block before recommending RFA, and if yours gave you clear relief, you are likely a candidate.
Thermal RFA uses heat to stop the targeted nerve from sending pain signals. Pulsed RFA uses brief electrical pulses without sustained heat and is used where thermal ablation is not advisable. Your physician recommends the one that fits your procedure.
Most patients call it briefly uncomfortable. Numbing medicine and sedation keep you comfortable during the procedure, and some soreness at the treatment sites for several days afterward is common.
You go home the same day after 30 to 60 minutes in recovery, with someone else driving. Expect some soreness for several days while the relief builds over the next 2 to 6 weeks.
No. Sedation and numbing medicine make driving unsafe that day, so plan for a ride.
RFA has a strong safety record when experienced physicians perform it under image guidance. Possible effects include a temporary increase in pain, soreness, bleeding or infection at a needle site, and rarely a complication from needle placement. Some patients notice numbness or a sunburn-like feeling over the treated area, which usually fades within a few weeks. Your physician reviews your own risks at consultation.
A steroid injection reduces inflammation and usually helps for weeks to a few months. RFA quiets the nerve that carries the pain, so relief from spinal RFA typically lasts 6 to 18 months. It is usually the next step after a diagnostic injection has confirmed the source.
For some patients it can. Genicular RFA can help some people with knee arthritis put off a knee replacement, and spinal RFA can help some patients put off back or neck surgery. Because RFA eases the pain without changing the joint itself, it may delay surgery rather than replace it, and your physician will tell you where you stand.
Pricing depends on the area, the technique and the number of levels treated, and it is reviewed at your consultation. When both sides need treatment, each side is done on its own day and priced separately. Follow-up visits are included in the procedure fee.
Yes. PHI regularly treats patients from Las Vegas, Palm Springs, London and beyond, and we coordinate the diagnostic block, the ablation and follow-up across your visits.
Book a Radiofrequency Ablation Consultation
Start with a consultation at our Beverly Hills office. Your physician reviews your imaging and any injections you have had, then recommends RFA or a diagnostic block as your next step. You can also call us at (310) 856-9488.