Pulsed Radiofrequency Neurotomy

Many patients have persistent pain related to a nerve injury or compression. Some patients may have pain that could normally be resolved with surgical decompression, but for various reasons, they are not able to have the necessary surgery. Sometimes, nerve injury can occur during surgery or from scarring that develops after surgery. Medications, therapy, and epidural injections selectively placed around the nerve root to "Hydro-Dissect" the nerve root can often be helpful.

If the pain is unresponsive to these techniques, one treatment option is Pulsed Radiofrequency Neurotomy (PRFN). This involves placing a standard radiofrequency needle at the nerve root using fluoroscopic guidance, just like with a Selective Nerve Epidural Injection technique. It usually takes 2-3 minutes to place the needle. Anesthetic and steroid are typically then injected. A thin probe is then inserted and the nerve is painlessly stimulated with Radiofrequency energy for 4-6 minutes at a low temperature. Current evidence suggests that there are no specific side effects to PRFN and no nerve injury beyond that expected from the needle placement, which is quite unlikely. The benefits vary, but about half of patients report 6-9 months of pain reduction, improved quality of life, and better function. It may be repeated as needed, and appears to work well with repeated treatment if it works with the initial procedure. More research is clearly needed for this potentially valuable tool.

PRFN is used often in Europe, but less in the United States at this time. There is no AMA-approved "official" billing code for this procedure as it is still considered investigational by Medicare. Thus, it is provided on a self-pay basis.